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COPYRIGHT DEPOSIT, 



Surgical and Obstetrical 
Operations 



BY 



W. L. WILLIAMS 



Professor of Surgery and Obstetrics in the New York State Veterinary 
College, Cornell University. 



Embodying portions of the Operationscursus of Dr. W. Pfeiffer, 
Professor of Veterinary Science in the University of Giessen. 



SECOND EDITION, REVISED 



Published by the Author 

Ithaca, N. Y. 

1907 






\\ 



.-^s 

\^^^ 



PRESS OF 

ANDRUS & CHURCH, 

ITHACA, N. Y. 



LIBRARY of CONGRESS 

Two CoDles Received 

DEC a «906 

* Copyright Entry 

CLASS A XXc, No, 

liol Z'^. 
COPY B. 



COHYRIGHT, I906, 

BY 
W. t,. WII,I.IAMS. 

J.. 



PREFACE. 

The author caused to be pubHshed in 1900 a booklet 
entitled : "A Course in Surgical Operations b}^ W. Pfeiffer 
and W. L. Williams," consisting of an authorized transla- 
tion of Dr. Pfeiffer' s Operations-Cursus with such changes, 
omissions and additions as were deemed desirable. Three 
years of constant use, with such criticisms as have come to 
the author from others, have served to point out desirable 
changes of so sweeping a character as to demand a practi- 
cally new treatise and to render the continuance of a formal 
joint authorship inexpedient. The author has drawn freely 
upon Dr. Pfeiffer' s Operations-Cursus in the preparation of 
the text which in man}' chapters is practically copied there- 
from, including the illustrations, and gratefully acknowl- 
edges his profound obligations thereto. On the other hand 
nothing has been copied or extracted except it could be freel}' 
adopted as the author's own view, releasing Dr. Pfeiffer 
from all responsibility for the character of au}^ of the con- 
tents. 

The volume is primarily designed for the use of the auth- 
or's classes in laboratory surgery and embrN^otomy in which 
the student performs the surgical operations described, on 
animals procured for the express purpose, under chloroform 
anaesthesia whenever possible, after which the subject is 
destro3^ed while still anaesthetized ; at the same time it has 
been aimed to render the volume of the greatest possible 
value to the practitioner consistent with this plan. The 
operations included under this scheme are necessaril}^ limited 
to those which can be reasonably well performed on com- 
paratively sound animals of little value and regularly pro- 
curable for laboratory purposes. The list covers a wide 
range and is designed to give to the student as thorough 
training as is practicable in a laboratory course and includes 
well* nigh all the more important varietes of confinement, 
anaesthesia, disinfection, sutures, bandaging, dressing and 
other adjuncts to operative work. The chapter of trephin- 



IV PREFACE. 

ing of the facial sinuses had been dealt with at length in 
order to fully and clearly describe the author's method of 
operating ; a new operation for poll evil has been inserted 
and there has been included a description of some of the 
most important embryotomy operations as the}^ are carried 
out in the laboratory by means of freshly killed, new born 
calves which are placed in the position described, in the arti- 
ficial uterus of a specially prepared skeleton . 

Generally but one method of operating is described, the 
one chosen being that which in the author's experience has 
proven the most valuable in actual practice, and no opera- 
tion has been introduced purely for practice but each one 
has been tested and known to have practical value. 

Where two methods of operating are given, they are 
inserted because each has definite points of superiority over 
the other and one method may be specially applicable in a 
given case, another in a different patient where the same 
operation is to be performed as for example, a milk cow is 
best spayed through the vagina while a heifer must be 
operated on by an incision through the abdominal walls. 

Considerable stress has been laid upon the surgical an- 
atoni}^ of the parts involved in each operation ; some uses of 
the various operations are mentioned ; some of the chief 
dangers of each are pointed out and in some cases references 
to literature upon the operation or the diseases for which the 
operation is designed, are cited. 

The figures in the text except Nos. 5, 10 and 11, and the 
Plates Nos. I, II, VIII, X, XII, XIV, XVII, XVIII, 
XXI, XXII, XXIII, XXV, XXVIII and XXIX are from 
Dr. Pfeifi'er's Operations-Cursus ; Plate No. Ill was drawn 
by Dr. C. F. Flocken, Bureau of Animal Industry, Wash- 
ington, D. C, and the remaining Plates were drawn under 
the direction of the author by Mr. C. W. Furlong, in- 
structor in Industrial Drawing and Art in Sibley College, 
Cornell University. 

W. L. W1LI.IAMS. 
Cornell University October, igoj. . 



PREFACE TO SECOND EDITION. 

The rapid exhaustion of our first edition has been highly 
gratifying to the author by indicating the appreciation of 
students and practitioners. 

We now submit a second edition which has been revised 
and somewhat extended. In our revision we acknowledge 
with thanks numerous valued suggestions from Drs. Liau- 
tard, Adams, Udall and others to which we have given 
careful consideration. 

As before it has been aimed to continue the volume as a 
brief, concise handbook of the technic of a number of the 
most important surgical proceedures, omitting the details 
common to all or most operations, and assumed that the 
student or practitioner has learned these otherwise. 

Our illustrations have been materially changed from the 
first edition. Plates IX, XI, XIV, XX, XXI, XXIV, 
XXV, XXVI, XXVIII, XXXI, XXXII, and Figures 
I to 8 and 12 to 14 are from Pffeiffer's Operations-Cursus, 
while the other plates and figures have been made especially 
for this work under our personal supervision. 

The present edition is submitted with a full conscious- 
ness of its many defects. 

W. L. Williams, 
Cornell University , Ithaca, N, Y. 

December, 1906. 



CONTENTS. 
I. 

I. OPERATIONS ON THE HEAD : 

Page. 

1. Kxtraction of Teeth i 

2. Repulsion of Teeth 8 

Trephining the Facial Sinuses i6 

3. Trephining of the Frontal Sinuses 19 

4. Trephining the Maxillary Sinuses ^ 31 

5. Trephining the Nasal Fossae 37 

6. Poll Kvil Operation 41 

7. Ligation of the Parotid Duct 45 

8. Entropium Operation 50 

9. Staphylotomy 51 

10. Trifacial Neurotomy 55 

II. OPERATIONS ON THE NECK : 

11. Opening the Guttural Pouches 57 

12. Tracheotomy ^ 63 

13. Arytenectomy 65 

14. Roaring Operation by Kxcision of the Vocal Cords and Ven- 
tricle of the Larynx 70 

15. Intra-tracheal Irrigation 75 

16. Intravenous Injection 75 

17. a. Phlebotomy with Fleams 77 

b. Phlebotomy with Lancet 78 

c. Phlebotomy with Trocar 79 

18. Ligation of the Carotid Artery 79 

19. CE^sophagotomy 84 

III. OPERATIONS ON THE TRUNK AND ON THE GENITAI. ORGANS : 

20. Puncture of the Chest 86 

21. Puncture of the Intestine 87 

22. Subcutaneous Caudal Myotomy 89 

23. Caudal Myectomy for Gripping of the Reins 91 

24. Amputation of the Tail 95 

25. Urethrotomy 100 

26. Amputation of the Penis 103 

27. Vaginal Ovariotomy in the Mare 108 



CONTENTS. vii 

28. Vaginal Ovariotomy in the Cow 119 

29 Ovariotomy in the Cow by the Flank 121 

30. Ovariotomy in the Bitch by the Flank 122 

31. Ovariotomy in the Bitch by the Linea Alba 129 

32. Ovariotomy in the Cat i^i 

33. Castration of Cryptorchid Horses 132 

IV. OPERATIONS ON THE EXTREMITIES : 

34. Tenotomy of the Flexor Tendons of the Foot 142 

35. Tenotomy of the Peroneal Tendon (Stringhalt Operation )___ 144 

36. Tenotomy of the Cunean Tendon (Spavin Operation) 146 

Neurotomy j^3 

37. Digital Neurotomy i^i 

38. Plantar Neurotomy jcg 

39. Median Neurotomy . i5q 

40. Ulnar Neurotomy j5y 

41. Sciatic Neurotomy ^j-i 

42. Anterior Tibial Neurotomy 183 

43. Resection of the Lateral Cartilages 185 

44. Resection of the Flexor Pedis Tendon 192 

45. Amputation of the Claws of Ruminants 194 

46. Bayer's Sutures 190 

II. 

EMBRYOTOMY OPERATIONS ! 

47. Cephalotomy 203 

48. Decapitation 205 

49. Subcutaneous Amputation of Anterior Limb 206 

50. Amputation at the Humero-radial Articulation 208 

51. Detruncation 208 

52. Destruction of the Pelvic Girdle, Anterior Presentation 212 

53. Amputation of the Limbs at the Tarsus 216 

54. Intra-pelvic Amputation of the Posterior Limbs, Breech Pre- 
sentation- 220 

55. Evisceration of the Fetus 229 



INTRODUCTION. 

Many details must be omitted in the succeeding text which 
are of importance in each operation, but which, if inserted, 
would render the volume unwieldy in size for the purposes 
designed. 

These details are in a measure alike in each case, and it is 
assumed that the student has already familiarized himself 
with them. The more important of these may be summa- 
rized as follows : 

1. The subject should be securely confined in each case 
as directed, because the method designated has been found 
effective in the operation under description, and serves to fix 
the relations of the parts in such a way as to conform to the 
surgical anatomy of the region as outlined in the text. It 
is to be constantly borne in mind that a change in the atti- 
tude of the animal is capable of causing profound alterations 
in the relations of parts which may greatly embarass the 
operator, or even prevent his carrying out the operation 
according to the technic given. In securing an animal for 
operation we must confine the whole body in a way that will 
sufficiently control its movements and will insure safet}^ to 
the patient and operator and the part to be operated upon 
must be so fixed as to properly limit its motion and in the 
position which affords the greatest facility for the carrying 
out of the operation according to the best technic known. 

2. Anaesthesia should be carefully carried out everywhere 
possible, because in addition to the humane sentiments in- 
volved, the resulting most perfect control of the animal is 
an essential in aseptic or antiseptic surgery. The student 
should make a careful study of anaesthesia in these exercises 
and acquire invaluable experience and confidence for use in 
actual practice. 

3. Disinfection must be scrupulousl}^ applied in every de- 
tail since upon its effectiveness must hang the verdict of 



INTRODUCTION. ix 

success or failure as measured by modern surgical knowl- 
edge. The operator's hands and, if need be, his arms 
should be thoroughl}^ scrubbed with a stiff brush in hot 
water with soap for a period of fifteen minutes, the finger 
nails well trimmed and cleansed, and all dirt and old epider- 
mal scales removed. The parts may then be disinfected by 
immersing in a hot concentrated solution of permanganate 
of potassium for ten minutes and then decolorized in a strong 
solution of oxalic acid in sterile water. Or the hands may 
be disinfected after the washing with soap and water by im- 
mersing and scrubbing them for ten minutes in a i to looo 
solution of corrosive sublimate, but in order to make this 
thoroughly effective the solution needs be alcoholic, or the 
hands should first be immersed in alcohol, ether, or other 
substance capable of dissolving fats and permitting the dis- 
infectant to penetrate the sebaceous glands. Great care 
should be exercised by the student to not touch any object 
after the hands have been disinfected for the operation unless 
it also has been disinfected or sterilized, or in case it becomes 
necessary to touch objects not sterile, the disinfecting process 
should be repeated before proceeding further with the oper- 
ation. This constitutes one of the most difficult of all de- 
tails for the beginner to acquire, and each failure should be 
remedied by repeating the disinfection over and over until 
the habit of maintaining effectual steriHzation is acquired 
and fixed. 

The operation field should always be carefully shaved be- 
fore beginning the operation, and the shaved area should 
always be very ample, so as to insure against contamination 
from adjacent hairs, as well as to give a clear view of the 
field. The area should then be disinfected in a reliable 
manner, that advised for the operator's hands serving as a 
t3^pe. Whenever circumstances will permit the operation 
field should.be kept in an antiseptic bath or pack for twenty- 
four hours prior to the operation in order that the deeper 
parts of the skin, especially the hair follicles and sebaceous 



X IN TROD UCTION. 

glands, shall become thoroughly disinfected, a process well 
nigh impossible in a short period. 

The suturing, dressing and bandaging of the wound 
should be carried out carefully in every case and no opera- 
tion left w^ithout completing it in the best manner possible. 

The student should make each operation as real as possible 
and not omit any detail, even if he thinks he already knows 
it sufficiently well, as the repetition of a supposedly familiar 
detail serves an important purpose in the fixing of a habit 
which is inestimably more valuable to the surgeon than any 
theoretical knowledge of technic. 

The safe surgeon is he who has so accustomed himself to 
the technic of asepsis and antisepsis that he carries them 
out rigidly in an automatic manner and can leave his atten- 
tion riveted on the surgical problems before him. 

The student who consults his interests will go yet farther 
and prior to undertaking any operation on the living subject 
will study the regional anatomy of the part on the cadaver 
and learn therefrom all that he can of the structure of the 
part which he must finally complete upon the living animal. 
No dissection of the cadaver can ever teach true surgical 
structure as the dead tissues can not be like the living, but 
such dissection can and does give great aid and should be 
pursued as far as it can lead and enough will still remain to 
be learned on the living subject. 

He should further take occasion to study in connection 
wnth each operation the object or objects for which it is 
performed in practice, its effect on the diseased or other 
parts, the untoward results to be anticipated, etc. 

Suggestions occur from time to time in the text designed 
to aid the student in these lines and help weave connecting 
bands between the operation, its objects and results. 

Surgical operations are in themselves valueless or worse 
and acquire value only when properly correlated to disease 
and skillfully performed. 

\ 

% 



Surgical and Obstetrical Operations. 



L SURGICAL OPERATIONS. 



OPERATIONS ON THE HEAD. 
I. EXTRACTION OF TEETH. 

PlvATE I. 

Prefatory remarks. The grinding teeth of the horse, 
consisting of three molars and three premolars in each row, 
are of such dimensions and attachments that their removal 
in case of disease or defect often presents difficulties of no 
small degree. 

These teeth attain their greatest size at the time of erup- 
tion and most of each remains firmly imbedded in its 
alveolus while a very shallow crown projects into the buccal 
cavit}^ The teeth are gradually pushed out of their alveoli 
as their crowns are worn away with age and the proportion 
of the intra to the extra-alveolar part gradually decreases 
until in very old animals the alveolar cavities become obliter- 
ated and the last vestige of what was once the apex of the 
fang rests insecurely in the buccal mucous membrane. 

The facility with which teeth may be extracted increases 
as the age of the animal, being easily drawn with forceps 
in the old, while in case of freshly erupted teeth in the 
young horse we have usually been unable to extract them 
with forceps of'any kind, except in those where they have 
become somewhat loosened as a result of disease or accident. 
When aberrations in development occur, leading to the for- 
mation of dental tumors or odontomes the possibility of ex- 
traction by means of forceps is frequently wholly excluded 
and in cases where dental disorder has led to empyema of 
the facial sinuses, even if the tooth may be drawn by means 
of forceps, further operation is generally necessary, in order 



2 EXTRACTION OF TEETH. 

to assure a prompt recover}^, by the removal of the effects 
of the disease of the tooth. 

The removal of molars may therefore involve extraction 
with forceps, trephining the dental alveolus and repulsion 
of the tooth and trephining of the sinuses because of em- 
pyema or other pathologic conditions referable to the dental 
affection ; consequently all of these should be studied as re- 
lated topics. 

Instruments. Extracting forceps, fulcra of various 
sizes, mouth speculum with abundant lateral working room, 
exporteur forceps, toothpick, splinter forceps, reflecting lamp. 

Technic. In simple cases with a quiet animal the pa- 
tient may be sufficiently confined by being backed into a 
corner or very much better b}^ securing in stocks. In com- 
plicated cases or very resistant animals it is best to place 
upon the operating table or in default of this, cast and secure 
in lateral decubitis on the sound side. 

Apply the speculum and identify the diseased tooth by 
manual exploration ; determine if the tooth is of unnatural 
size or form, if it is loose, if the gums are separated from the 
neck at any point, if it is out of line with the other teeth in 
the row, if it is painful to the touch, if it be split, etc. An 
external tooth fistula or a tumefaction over the affected 
member may aid in distinguishing it. Aid may also be had 
by illuminating the mouth with a reflecting electric or other 
lamp. 

Remove any accumulations of partiall}^ masticated food 
by means of the toothpick or with the fingers. 

In applying the forceps, have an assistant draw the 
tongue out at the commissure of the lips on the side oppo- 
site to the affected member and introducing one hand into 
the mouth, place the index finger on the posterior border 
of the diseased tooth and with the other, push the opened 
forceps backward upon the dental row until they reach it, 
then firmly grasp the diseased tooth with the instrument, 



EXTRACTION OF TEETH. 3 

pressing the jaws down as deeply as possible against the 
alveolus. In many cases the diseased tooth can be clearly 
seen, especially with the aid of the reflecting lamp, and the 
forceps may be readily applied by visual aid and this is 
frequently preferable to the sense of touch. Withdraw the 
free hand from the mouth, grasp the handles firmly and 
loosen the tooth in its alveolus by establishing and maintain- 
ing as long as necessary a gentle to and fro lateral move- 
ment. The tooth is thus loosened in its alveolus by caus- 
ing it to revolve very slightly back and forth on its long 
axis, thereby spreading the cavity. When the tooth has 
become well loosened, as indicated by its revolving with 
the forceps and by the audible crepitant sound caused by 
the passage of air bubbles to and fro through the blood 
and lymph in the alveolus, maintain the forceps in position 
with one hand and with the other introduce the fulcrum to 
a point where the depression on its superior surface will 
receive the projecting rivet-head of the instrument or in an 
otherwise secure position and give it a safe support, while 
the inferior surface rests evenly upon the crown of a tooth 
anterior to that which it is desired to extract, as is shown 
in Plate I. The fulcrum needs be held firml}^ in place in 
order to prevent it from gliding forward under pressure. 
In extracting the first premolars there is no opportunity 
for resting a fulcrum on teeth anterior thereto and con- 
sequently forceps have been made with fulcra beyond the 
forceps jaws resting upon teeth more posteriorly situated- 
This is not essential. If the tooth is thoroughly loosened, 
as it should be, one hand placed in the interdental space 
with the dorsal surface against the jaw and the volar grasp- 
ing the instrument, will serve as an effective fulcrum. In 
other cases an iron or steel fulcrum is not essential, but a 
stick of hard wood of proper size and form acts quite as 
efficiently and may even keep its position better because 
the teeth upon which it rests sink into it somewhat. On 



Pirate I. 
Extraction of Teeth. 

Sagittal section through the oral cavity, show- 
ing plan for extracting the third inferior pre- 
molar, viewed from within the mouth. 

A Forceps ja\\s applied to third premolar. 

B Fulcrum resting upon first premolar. 

CC, Plates of mouth speculum resting up- 
on incisor teeth. 



EXTRACTION OF TEETH. 7 

the whole the fulcrum is not so important as some have 
considered it, since, after a tooth is loose enough to be 
drawn with its aid, a very trifling additional loosening will 
permit it to be easily lifted from its alveolus without it. 

The tooth fang is extracted by forcing the handles of the 
forceps toward the jaw in which it is located, so that as it 
is gradually drawn out the forceps tend to pivot on the 
fulcrum in a way to permit it to emerge from the alveolus 
in the direction of its long axis. B}^ referring to Plate II 
it will be seen that the axes of the different teeth vary, 
that of the molars being obliquely forwards towards the 
incisors while the crowns of the premolars are directed 
obliquely backwards toward the molars. The slant of the 
teeth is most marked at the ends of each arcade while at 
the middle they acquire a practically perpendicular position. 
In drawing the last molar the forceps will generally strike 
against the opposite dental arcade before the tooth has 
codipletely emerged from its alveolus and in order to com- 
plete its removal it may be necessary to take a deeper hold 
with the extracting forceps or withdrawing these complete 
the operation with the aid of exporteur forceps, or still 
better frequently with the hand. In young horses where 
the teeth are very long we have found it impossible to 
complete the extraction until the tooth had been divided 
transverse!}^ by means of the tooth cutting forceps. 
The dangers in the extraction of teeth are chiefly : 
I. The fracture of the tooth, leaving the fang still 
fixed in the alveolus, a danger not infrequently unavoidable 
when the crown has become greatly weakened by disease so 
that it lacks the power of resistance necessary to its extrac- 
tion ; under most other conditions it may be largely guarded 
against by the careful securing of the patient in a manner 
to effectively prevent sudden throwing of the head while the 
forceps are applied, and by using good judgment in the 
amount of force exerted while loosening the tooth in its 



8 REPULSION OF TEETH. 

alveolus. As stated above we should not expect to be able 
to extract with forceps the teeth of very young horses 
which have not become partly detached by disease or in 
which the fangs are the seat of adontomes. 

2. Fracture of the alveolar walls is an accident which may 
generally be prevented by proper care in the application of 
force and the avoidance of any attempt to extract a tooth 
when the existence of an enlargement of the fang is apparent 
or suspected. 

3. The tooth may slip from the forceps into the pharynx 
and be swallowed, an accident avoidable by inserting the 
hand into the mouth along with the forceps as the tooth be- 
gins to emerge and if need be grasp it with the fingers. 



2. REPULSION OF TEETH. 
Platk II. 



Uses. The removal of molars, pre- molars, tooth fangs 
from which the crowns have been broken away, alveolar 
odontomes, etc., which can not be removed safely by means 
of the forceps. 

Instruments. Razor, convex scalpels, trephine, bone 
gouge, Luer's sharp bone forceps, (rongeur forceps) light 
and heavy bone chisels, mallet, tooth punch, curette, com- 
pression artery forceps, scissors, needles, thread, absorbent 
cotton, antiseptic gauze, extracting forceps, splinter forceps, 
tenacula, metal probe, mouth speculum. 

Technic. Secure the animal in the lateral recumbent 
position with the affected side up. The operating table 
affords by far the best means for securing for the conven- 
ience and safety of operator and patient. If the sinuses are 
so involved as to make possible the inhalation of pus, blood 
or other injurious matter, perform tracheotomy in ample 
time to avert danger. Anaesthetize locally or generally as 
required. Shave and disinfect the operative area and 

\ 



REPULSION OF TEETH. 9 

trephine according to the method described in the following 
chapter down through the alveolar plate immediately over 
the fang of the affected tooth. Avoid dulling the trephine 
by striking it against the tooth fang itself. If an external 
fistula exists the identity of the affected tooth is best 
determined by passing a metallic probe through it against 
the diseased fang while one hand is passed into the mouth 
and the location of the probe more fully ascertained. Care 
should be exercised in trephining to not injure the adjoining 
teeth. After removing the disc of bone isolated by the 
trephine, control all hemorrhage and then enlarge the open- 
ing and remove the bony tissues till the tooth fang is bared 
its entire width. Insert a scalpel or bone chisel between the 
bone and soft tissues at the margin of the trephine opening 
nearest the mouth and with one hand in the oral cavitj' 
with the fingers resting upon the alveolar border on the 
lateral side of the tooth to serve as a guide, push the 
scalpel or chisel along between the bone and soft tissues 
until it emerges from the gums alongside the affected tooth 
and extend this separation backwards and forwards until 
the soft tissues are completely detached from the alveolar 
wall over the entire area of the diseased member. When 
operating upon the superior molars the fangs of which are 
covered by the zygomatic ridge, the chisel or scapel cannot 
be pushed directly from the trephine opening into the mouth 
between the soft tissues and the bone because the line is 
concave instead of direct. In these cases it is best to 
detach the soft parts only from the zygoma at first and then 
remove the alveolar plate of the ridge, after which the line 
into the mouth is direct and the instrument can then be 
readily pushed between the soft and osseous tissues for the 
remainder of the distance and the separation completed. 

In operating upon the inferior molars covered by the 
masseter an opening may be made near its lower border 
large enough to admit the trephine or the muscle may be 





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REPULSION OF TEETH. 13 

detached at its point of insertion and two parallel incisions 
carried upwards a short distance, permitting the raising of 
a flap or what is generally best, a curved incision is made 
along its antero-inferior border parallel to the parotid duct 
and satellite vessels and just anterior to them (or posteri- 
or if preferred ) and the muscle lifted up and drawn back- 
wards sufficiently exposing the parts. 

With a light, narrow bone chisel cut away and remove 
the external alveolar plate over the entire extent of the 
tooth, from the oral maigin of the trephine opening into 
the mouth cavity. Hold the chisel so that the outer edge is 
inclined from the affected tooth toward the adjoining one, 
thus making a bevelled channel through the alveolar plate 
tending to loosen the isolated section of bone by driving it 
outwards. Drive the chisel for a short distance on one 
side, then upon the other, and thus break the alveolar plate 
away in small sections and avoid an extension of the 
fracture to neighboring alveoli and damage to adjacent 
teeth. Care should be taken that the bone chisel is sharp 
otherwise extensive fractures of the bone may occur. With 
gouge and chisel remove all remnants of bone over the 
lateral side of the tooth laying it completel}' bare as shown 
in Plate II. The soft tissues of the part should not be dis- 
turbed be3'ond the excision of the circular piece, correspond- 
ing to the disk of bone removed by the trephine and the 
detaching of them from the portion of bone to be chiseled 
away. When the tooth has been bared so that every part 
of its lateral surface can be seen or felt, the punch may be 
placed against the end of the fang, a few firm, quick blows 
given with the mallet, so directed that the force is in a line 
with the long axis of the tooth, and the organ driven into 
the mouth where it is seized by the forceps or the hand 
and removed. If it is not readily and safely dislodged in 
this way, place the heavy bone chisel against it and with 
the aid of the mallet comminute the tooth by breaking it 



14 REPULSION OF TEETH, 

transversely and splitting it longitudinally, in which pro- 
cess the fragments are generally loosened and can then be 
readily removed with the aid of the gouge or heavy dress- 
ing or splinter forceps. Remove carefully all fragments of 
tooth or of loosened bone, cleanse and disinfect the wound, 
pack with iodoform gauze and dress daily. 

In cases where a fistulous opening remains after repulsion 
of molars without the removal of the alveolar wall, or if a 
tooth has been drawn by means of the forceps and the 
alveolus fails to heal, the bony plate should be removed in 
the above manner. 

Dangers. Wounding of the adjoining tooth is to be 
avoided chiefly by carefully locating the fang of the affected 
one and placing the instrument as exactly as possible over 
its centre, by using a trephine not exceeding 2 to 5 cm. in 
diameter and cautiousl}^ sawing through the compact layer 
of the external plate only, removing the cancellated tissue 
with the gouge and extending the opening in the desired 
direction after the outlines of the tooh fang have been 
clearly determined. If an adjoining fang is wounded, the 
tooth should be removed as it will not heal but will result 
in a permanent tooth fistula. 

Fracture of the alveolar walls of the inferior maxilla 
may occur during the removal of the external alveolar plate 
with the chisel or of the repulsion of the tooth with the 
punch and mallet. The first is to be averted by care in 
having the chisel sharp, by observing the precaution of 
making a bevelled cut through the bone, by using only 
moderate blows and driving the instrument alternately for 
a short distance on each side. The second danger of ex- 
tensive fracture may be averted by being cautious to see 
after each stroke on the punch that it has not slipped in- 
ward along the median side of the tooth, pressing the in- 
ternal plate awa}^ from the tooth row and tending to pro- 
duce a longitudinal fracture nearly or quite as long as the 



REPULSION OF TEETH. 15 

dental arcade. Careful digital exploration in the mouth 
may discover this fracture while still ' ' simple ' ' but a 
stroke or two more will convert it into the very much 
more serious "compound" fracture opening into the oral 
cavity. Keeping one hand constantly in the mouth at the 
point of impact is always desirable as a precautionary 
measure. Transverse fracture of the tooth while yet in 
situ by means of the bone chisel, as above described, is a 
great safeguard against this injury by lessening the force 
required in repulsion and by the removal of the tapering 
fang, which then leaves a more secure base for the punch to 
act upon. It should never be forgotten that the impact from 
the punch must always be as nearly parallel to the long axis 
of the tooth as is possible. 

The fracture of the superior maxilla and bony palate is 
not so probable as the preceding and is preventable by mod- 
erate care in the denuding of the tooth before punching, by 
comminution of the tooth in bad cases, by the careful ad- 
justment of the punch and applying the force in the proper 
direction. 

Literature. Odontomes, Sir Bland Sutton, Jour. Comp. 
Med. and Vet. Arch, Vol. XII. p. i ; A Clinical Study of 
Odontomes, W. L. Williams, Am. Vet. Review, Vol. XV, 
p. I ; Notes on Odontomes, do ; Am. Vet. Rev. Vol. XXIII, 
p. 82 and Oest. Mon. Thierheilkunde, Bd. XXIV, s. 122. 



1 6 TREPHINING OF THE FACIAL SINUSES. 

TREPHINING OF THE FACIAL SINUSES. 

PI.ATES in, IV, V, VI, VH AND vin. 

Prefatory Note. The facial sinuses of the horse consti- 
tute an exceedingl}^ intricate and extensive group of cavities, 
communicating more or less freely with each other and with 
the exterior through the medium of the upper air passages, 
of which they are to be regarded as a part. 

Their arrangement and relations permit them to frequently 
become the seat of, or central figure in many forms of disease 
which require for their differential diagnosis, amelioration or 
cure, the operation known as trephining. Their extent and 
relations to each other and to surrounding parts varies 
greatly with age and ma}^ be profoundly changed as a result 
of disease, amounting not infrequently in the frontal, 
superior and inferior maxillary sinuses ceasing to exist as 
separate cavities and becoming merged into one vast diverti- 
culum. Similar changes may occur in the nasal and tur- 
binated cavities. The general position, extent and relations 
of these are indicated by Plates IV, V, VI, VII and VIII. 

It is to be noted that in cross sections the superior and 
inferior maxillary sinuses appear to be reversed in relation 
to their nomenclature. It is difficult to make a cross sec- 
tion of these sinuses in such a manner that the superior 
sinus does not show between the inferior one and the oral 
cavity. The inferior maxillary sinus is inferior in the 
sense that it is nearer to the nasal opening so that with the 
head in a vertical position or in a longitudinal section the 
inferior sinus is below the superior, while if the head be 
placed horizontally or a cross section made the superior 
sinus is below the inferior. 

The uses of trephining are in a measure common to all 
the sinuses and are chiefly for the relief of empyema of the 
cavities involved, necrosis of the bony or cartilaginous walls, 
tumors of various kinds, especially dental in the young and 
malignant growths in the old, foreign bodies in the sinuses, 
differential diagnosis of diseases of this region, etc. 



TREPHINING OF THE FACIAL SINUSES. 17 

Veterinarians trephine the sinuses by two fundamentally 
different plans ; with, and without excision of the cutaneous 
disk corresponding to the piece of the bone removed. The 
first is generally used in Great Britain and North America, 
while the last is the prevailing method in continental 
Europe and other parts of the world. The reason assigned 
for these variations in method are conflicting. To us there 
seem to be adequate reasons for preferring the excision of 
the cutaneous disk. We regard as the chief considerations 
in an operation the following : the avoidance of infection ; 
the prevention of pain during the operation or the after- 
treatment ; the reduction of the scar to a minimum ; rapidity 
and certainty of recovery ; convenience in operating and 
dressing. Infection is largely dependent, aside from 
aseptic operation and protective dressing, upon the area of 
the wound, the facility for maintaining cleanliness and the 
degree of disturbance to the tissues while being dressed. 
The wound area in the bone is alike in all cases but that in 
the skin varies greatly. If we take as a type the usual 
European technic and compare it with that given below we 
w^ould find the wound areas approximately as follows : in 
the European method 2.2 sq. in. while in the operation as 
given below we have only about .44 sq. in. or proportion- 
atel}- the wound area in the soft tissues in the European 
operation to that given below would be as 5 : i . 

It is very evident that the technic given below affords 
immeasureabh^ better facility for maintaining cleanliness in 
the wound and with a minimum amount of insult to the 
tissues in the process of dressing. 

The amount of pain caused in the operation would depend 
chiefly upon the extent of the skin incision which is equal 
in the two plans so that the onl}- difference would be in the 
dissection of the skin from the bone in the European 
operation. Tht pain caused in dressing must be greater in 
the European method because the detached, overhanging 
2 



1 8 TREPHINING OF THE FACIAL SINUSES. 

skin must be moved and disturbed each time causing pain 
and inviting infection. The question of pain must always 
be seriousl}?- considered as it not only affects the time re- 
quired for dressing and its efficacy, but has an important 
relation to the docility of the animal after recovery, some 
horses having their dispositions permanently ruined by the 
irritation due to the oft repeated painful dressing of wounds. 

The cicatricial contraction of the tissues of the horse is 
so great that the removal of a circular disk of skin J^ to i}^ 
in. in diameter on the face does not leave a visible scar 
so that the question of blemish falls back upon that of in- 
fection, which, as we have asserted above is far more 
probable by the European method. 

The rapidity and certanity of recovery are dependent 
upon the considerations above discussed. The removal of 
the cutaneous disk is certainly easier and quicker than the 
other method. The convenience for dressing is evidently 
superior by the English and American method. 

The opening of the maxillary sinuses into the nostrils is 
based upon the surgical principle that suppurating cavities 
should be provided with ample drainage from the most 
dependent part. The direction to leave the external wound 
open, at first thought seems antagonistic to general surgical 
principles but it should be remembered that the wound 
consists only of the incision through the skin, connective 
tissue and bone, and that au}^ plug which we can put in 
this opening can only serve to dam back the secretions of 
the cavity and can not prevent it from coming in contact 
with the wounded surface. It must further be regarded 
that the respiratory mucosa of the upper air passages are 
not irritated or injured in any manner so far as we can ob- 
serve clinically by the direct admission of air into them 
through a trephine, or other artificial opening, but on the 
contrary the suppuration in a sinus is constanth^ aggravated 
b}^ the retention of the pus and exclusion of air and re- 
covery facilitated b}' thorough drainage and aeration. 



TREPHINING OF THE FRONTAL SINUSES. 19 

3. TREPHINING OF THE FRONTAL SINUSES. 
PI.ATES III- VIII. 

Uses. Fracture of the bony walls, necrosis, tumors. 

The ample communication below with the superior 
maxillary sinuses prevents the accumulation of pus or fluids 
in the frontal cavities even if formed therein unless the 
former become filled and the contents back up into the 
latter. In the case of empyema of the frontal sinus, trephin- 
ing does not generally give full relief but calls for a re- 
petition of the operation on the maxillary sinuses also. 

Instruments. Razor, scissors, convex scalpels, artery 
forceps, tenacula, probe, trephine, curette, gouge, Luer's 
sharp bone forceps (rongeur forceps), hammer, chisel, bone 
screw, lens-shaped bone knife, probe-pointed bistoury, 
dressing forceps, disinfecting and dressing materials. 

Technic. The operation may be performed upon the 
standing animal with the aid of local anaesthesia of the 
skin, the bone having virtually no sensation. Restless 
animals may be further secured with the twitch, in the 
stocks, upon the operating table or by casting on the sound 
side. Clip and shave the hair from the region of the front- 
al bone on a level with the superior border of the orbital 
cavity as indicated in Plate III or at any point below on a 
line extending from F toward a point midway between N 
and I M down to a level with the dotted line, S M, and dis- 
infect the area carefully. F represents the highest point 
at which the frontal sinus can be penetrated without injury 
to the cranium. " Within the shaved and disinfected area 
locate the point for trephining, F, Plate III so that the in- 
ferior border of the opening on a medium sized horse will 
be not higher than on a level with the superior border of 
the orbital cavity at the dotted line below F and the inner 
margin about i cm. from the median line of the face. With 
a heavy convex scalpel make a circular incision as large as 
the area of the trephine, directl}^ through the skin, subcutem 



Pirate III. 

Trephining the Faciai, Sinuses. 

F, highest point at which an opening may be 
made into the frontal sinus without wounding 
the cranium acd brain ; N, opening into nasal 
sinus ; SM, opening into superior maxillary 
sinus ; IM, opening into external portion of in- 
ferior maxillary sinus ; IM^, opening into the 
median portion of the inferior maxillary sinus. 




,N — 



5M 



TREPHINING OF THE FRONTAL SINUSES. 23 

and periosteum down to the bone and remove in one piece 
the entire mass of encircled soft tissues by seizing the skin 
with a tenaculum and forcibly separating the periosteum, 
from the bone with a scalpel or bone scraper. Control the 
hemorrhage. With the centre extended place the trephine 
accuratel}^ upon the denuded area perpendicular to the 
surface of the bone and grasping the handle firmly turn it 
to and fro until the bit has penetrated the bony plate and 
the saw has cut a distinct groove to serve as a guide 
w^hen the center should be retracted and the operation con- 
tinued until the disc of bone is detached, being careful to 
maintain the trephine prependicular to the surface. The 
operation is facilitated by grasping the shaft of the trephine 
between the thumb and fingers of one hand, constituting a 
support in w^hich it can glide back and forth. The pressure 
under which the sawing is carried out must not be too great. 
When the bony plate which has been isolated begins 
to loosen, remove the trephine and insert the bone screw 
into the centerbit opening and break out the piece of bone 
or pry it out with the bone gouge or chisel. Smooth any 
uneven edges of bone with the lens-shaped knife. The ab- 
normal contents of the frontal sinus can now escape through 
the opening or be removed with the curette, forceps or scis- 
sors, and the cavity irrigated with an antiseptic fluid. Leave 
the trephine wound entirel}^ open and dress daily with anti- 
septics. The frontal sinuses being in free communication 
with the superior maxillary, and the superior turbinated 
bone of the same side forming its median wall, indirectly 
the irrigating fluid can escape through the nasal opening 
by way of the former or by a perforation through the 
latter. 

In order to prevent the aspiration of the contents, which 
are generally purulent, or ma}^ consist of blood or irri- 
gating fluids, and to facilitate their escape, irrigation should 
be carried out with the poll elevated and the head flexed. 



Pirate IV. 

Trephining of Faciai, Sinuses. 

Cross section of the right half of the head of 
a horse at the posterior border of the last molar. 
F, frontal sinus ; IM, lateral portion of inferior 
maxillary sinus at extreme posterior or superior 
part ; IM^, median portion do. ; N, nasal 
chamber opposite the communication between 
it and the superior maxillary sinus ; NF, con- 
duit of superior maxillary branch of the trifacial 
nerve ; S M, superior maxillary sinus ; M^, 
fragment of last molar. 



IM — 




~-- — M 



TREPHINING OF THE FRONTAL SINUSES. 27 

By studying Plates IV-VII it will be seen that any collec- 
tion of pus or other disease products at F would result in poor 
drainage so far as may be obtained by trephining through 
the external wall only, and consequently in order to com- 
plete it aside from that through the superior maxillary sinus 
an artificial communication between it and the nasal fossa 
may be made at ST, Plate VIII by a second opening oppo- 
site that point near the median line midway between F and 
N, Plate III, and then breaking through the thin walls of 
the turbinated bone b}' means of a probe or other suitable 
instrument and enlarging it sufficiently with the probe 
pointed bistoury or with the finger. In locating the exact 
point for making this opening in the turbinated bone it is 
advisable to pass a slightly curved heavy probe, a pair of 
long curved uterine dressing forceps or some other slightly 
curved and somewhat rigid instrument up the nostril to 
the operative region and having an index finger in the 
sinus against the median wall, the movements of the sound 
can easily be felt and the wall be broken down either by 
pushing the sound up into the sinus or thrusting the finger 
downwards into the nasal passage. 

In order to prevent aspiration of fluids, the animal must 
be allowed to get up immediatel}^ or if under anaesthesia a 
trachea tube should be inserted sufficiently early to avoid 
danger. Thread a long probe with a heavy suture about 
75 cm. long and inserting it through the trephine opening 
into the nasal passage draw it out through the nostril and 
removing the j)robe, attach a strip of gauze 75 cm. long to 
one end of the suture, draw it out through the nostril and 
tie the ends together on the side of the face to prevent dis- 
lodgement. Retain the gauze in position for about forty- 
eight hours to insure the permanency of the opening through 
the turbinated bone. In case of severe hemorrhage the 
cavity can be tamponed for twenty- four hours with a long 
strip of gauze which may be secured if necessary by sutur- 



PI.ATE V. 

Trephining the Faciai, Sinuses. 

Cross section of the left side of the head of an 
aged horse at the second molar, seen from the 
front. F, frontal sinus ; N, nasal sinus, oppo- 
site the communication between the nasal and 
inferior maxillary sinuses ; IM, lateral portion 
of inferior maxillary sinus ; IM^, median portion 
of inferior maxillary sinus ; SM, superior max- 
illary sinus ; NF, superior maxillary division of 
trifacial nerve in its bony conduit ; SZ. subzygo- 
matic artery ; P, palatine artery ; M2, second 
molar. 




-SM 



TREPHINING THE MAXILLARY SINUSES. 31 

ing to the lips of the wound. In practice the operation 
can be best carried out generally with the animal in the 
standing position the operative area being first anaesthetized 
by the use of cocaine or by inducing artificial oedema. In 
the standing position we largely avoid the danger of aspira- 
tion of fluids and the hemorrhage is greatly lessened. 



4. TREPHINING THE MAXIIvI,ARY SINUSES. 

Pirates III-VIII. 

Uses. Empyema, diseased teeth, odontomes, tumors. 

Instruments. Same as for the frontal sinuses. 

Anatomically there are two maxillary sinuses, superior, 
SM, and inferior, IM, Plates III-VII, having a thin im- 
perforate bony partition between them. This partition 
shifts somewhat in position with age and in case of disease 
undergoes profound changes in location and is frequently 
totally obliterated in cases of emp3^ema, dental cysts and 
other affections. If present, good drainage of the superior 
sinus may demand its surgical destruction so that some 
authors advise trephining directly over it in order to open 
the two cavities simultaneously. In extensive disease the 
prior destruction of the partition renders such an aim super- 
fluous ; in limited disease the opening of both cavities is ill 
advised. The partition may be ignored in operating for 
extensive disease and the trephine opening be aimed at the 
probable focus of the malady and, if missed, it should be 
located through the primary, or what now becomes an ex- 
ploratory opening, and a second operation made to directly 
reach the seat of the affection and if need be, 3^et a third to 
secure proper drainage. Shave and disinfect as much of 
the area as may be required bounded above by the inferior 
border of the orbital cavity, laterally by the zygomatic 
ridge, inferiorly by the lower end of the zygoma and 
medianwards by the middle line of the face. Determine 



32 TREPHINING THE MAXILLARY SINUSES. 

the proper point for operation by percussion or otherwise. 
If it is desired to enter only the superior maxillary sinus, 
SM, Plates III-VII locate the opening imniediateh' beneath 
the orbital cavit}' and in front of the zygomatic ridge, SM, 
Plate III, or at any point directh^ beneath this to midwaj^ 
between SM and IM, Plate III, at about the level of the 
dotted line IM'. In order to penetrate the inferior maxillary 
sinus at its lowest part, the trephine opening needs be 
located just in front of the lower end of the zygomatic 
ridge at IM, Plate III, or on a line obliquel}' upwards there- 
from as far as the furrow marking the suture between the 
maxillary and nasal bones at IM'. The trephining is 
carried out as described for the frontal sinuses. After the 
trephining has been completed remove any purulent collect- 
ion or tumors or carry out any other necessary operation in 
the affected sinuses and after cleansing, if the trephine 
opening does not insure perfect drainage of the lateral sac, 
either lower it by cutting away its inferior border with the 
bone forceps or make a second one at the necessary point. 
Under the influence of disease the sinuses may extend far 
beyond their normal location or may contract or become 
largel}" obliterated b}' being filled with new bone or soft 
tissue. The median portion of the sinuses on the inner 
side of the bon}^ conduit of the trifacial nerve, NF, Plates 
IV-VII, can not be drained properly through the openings 
SM and IM Plate III, and provision for this must generally 
be made by trephining into the inferior maxillary sinus at 
IM', Plate III, and then making an opening 3 to 5 cm. in 
diameter through the inferior turbinated bone at IT, Plate 
VIII, either with the finger, probe-pointed bistoury, or 
other suitable instrument, and inserting through this open- 
ing a long and thick strip of gauze which is brought out 
through the nostril and the ends tied together on the side 
of the face to prevent displacement. Retain this in position, 
renewing daily until the permanency of the opening is as- 
sured. ^ 



TREPHINING THE MAXILLARY SINUSES. 33 

If the partition between the two sinuses is intact it may 
be necessary to destroy it immediately above IM', Plate III, 
in order to drain the median portion of the superior maxil- 
lary sinus if that is required. If a molar has been removed 
and in so doing the bony wall leading down from the nerve 
conduit, NF, Plates IV-VII, destroyed in the operation, 
sufficient drainage may be afforded into the mouth and the 
opening through the turbinated bone rendered unnecessary. 
It generally occurs in extensive empyema of the sinuses 
that an opening in the turbinated bone takes place by 
necrosis and in some cases affords the desired drainage 
while in the majority the pathologic opening is so placed 
that it is incomplete. I^eave all wounds entirely open and 
irrigate daily with antiseptic solutions. 

Dangers. Care must be exercised to not injure the 
superior maxillary division of the trifacial nerve, NF, 
Plates IV-VII, either in trephining or after the sinuses 
have been opened. The bony conduit of this nerve is in 
rare cases entirely resorbed by pressure from dental cysts or 
other causes, leaving it stretched across the cavity as a white 
nacrous cord, intensely sensitive. Any injury to this nerve 
causes intense pain and renders the animal very resistant 
to the necessary manipulations in the after care of the 
wound and may leave it pernamently nervous about the 
handling of its face. 

Hemorrhage is generally not severe and may occur from 
the skin, where it should be controlled by compression or 
ligation ; from the inter-osseous vessels, where it may be 
checked by pressure with absorbent cotton, by pushing a 
small portion of cotton into the channel of the vessel with 
a needle or tenaculum or by plugging the vessel with a 
conical piece of wood ; from the wounded turbinated bones 
w^here it may be stopped by packing with cheese cloth. 
These tampons should be removed after twenty-four hours. 



PivATE VI. 

Trephining the Facial, Sinuses. 

Cross section downwards and backwards 
oblique through the half of the head at the first 
molar in a two year colt. F, frontal sinus ; N, 
nasal passage at point of communication with 
the inferior maxillary sinus, IM ; IM\ median 
portion of inferior maxillary sinus ; SM, ex- 
treme lower end of superior maxillary sinus 
opened ; Mi, first molar; M2 second molar; 
P, palatine artery ; SZ, sub- zygomatic artery. 




p- 



Ml 

52 




m 



•^;^ 




TREPHINING THE NASAL FOSSAE. 37 

5. TREPHINING THE NASAL FOSSAE. 

Uses. Operations on the septum nasi, upon the tur- 
binated bones, the removal of tumors or foreign bodies. 

Instruments. Same as for the frontal sinuses. 

Technic. The trephining is carried out by the method 
described above, in the region of the nasal bone, close by 
the median line of the face and according to indications at 
any point from a level of the dotted line, SM, Plate III, to 
the upper extremity of the false nostril. The operation 
should be immediately against the median line since other- 
wise the frontal or superior turbinated sinuses may be 
opened, the highly vascular superior turbinated bone 
wounded or an important inter-osseous artery in the nasal, 
just above its union with the superior turbinated, bone as 
shown in Plate VI, may be served. Special care is also 
necessary that the trephining should not be carried too 
deeply and that the osseous disc be carefully removed in 
order to avoid wounding the highly vascular turbinated 
bone, which lies in close proximity to it. The operative 
area is narrow and the trephine used should not exceed 2 
cm. in diameter. Whenever possible the operation should 
be carried out on the standing animal which decreases the 
hemorrhage and the danger from aspiration of fluids. The 
hemorrhage may be further controlled in operations upon 
the septum nasi and turbinated bones by spraying the parts 
with adrenaline chloride and cocaine. Even in the standing 
animal, if extensive operations are to be carried out on the 
very vascular septum nasi or on the turbine it is generally 
advisable to preform trachetomy before trephining, and re- 
tain the trachea tube in position until all danger has passed. 
When the animal is confined in the recumbent position the 
patient's safety demands that tracheotomy be performed 
before the operation is begun in almost all cases. Anaes- 
thesia may be maintained in such cases by means of an 
ordinary funnel with its tube bent at right angles and in- 



PI.ATE VII. 

Trephining of Faciai. Sinusks. 

Cross section of the left side of the head 
anterior to the last molar, and through the 
widest part of the inferior maxillary sinus. M^, 
last superior molar ; SM, superior maxillary 
sinus at its antero-inferior extremity ; IM, in- 
ferior maxillary sinus, lateral portion ; IM^ do. 
median portion ; N, nasal fossa ; S, sound lodged 
in lachrymal duct ; NF, trifacial nerve ; F, 
frontal sinus. 




— SM 



'■V 



•<^ 



^^-M 



POLL EVIL OPERATION. 41 

serted into the trachea tube while the chloroform is dropped 
on a towel spread over its mouth. After completing any 
required operation on the septum, turbinated bones or other 
parts, hemorrhage may be controlled b}' plugging one or 
both nasal fossae with single strips of gauze of sufficient 
size and carefully securing them by sutures to the sides of 
the trephine wound or otherwise. 



6. POI.L EVIIv OPERATION. 
Plate VIII. 

Instruments. Clipping shears, razor, sharp scalpels, 
probe-pointed bistoury, probe, lyUer's bone forceps, bone 
gouge, curette, suture and dressing material. 

Technic. Confine the animal in lateral decubitis prefer- 
ably upon the operating table, place under complete anaes- 
thesia and remove the halter or other headgear. 

Clip the foretop and mane and shave the forehead and 
the top of the neck back to a distance of 8 or 10 cm. or as 
much farther as may be required to pass beyond and be- 
hind the supposed extension of disease, and disinfect the 
area. With sharp scalpel make a longitudinal incision 
on the median line of the head and neck beginning at a 
point presumably posterior to the diseased area and carry- 
ing it over the poll down onto the forehead for a distance 
of 4 or 5 cm. "below the foretop. Continue this incision 
through the skin, the subcutem, the adipose tissue, AT, 
Plate VIII and either through or passing around alongside 
the neck ligament, LN, into the diseased area beneath the 
latter. Dissect the ligamentum nuchae away from the ad- 
joining tissues as far back as diseased and divide obliquely 
upward and backward as indicated at AA, and detach 
anteriorly from the base of the occiput. Be careful to re- 







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LIGATION OF THE PAROTID DUCT. 



45 



move every portion of the ligament in the area indicated 
and all calcareous deposits or diseased tissues. With Luer's 
forceps groove a channel about 2 cm. wide from behind to 
before directly upon the median line through the occipital 
protuberance to the depth of about 2 cm. making the bottom 
as near as possible on a level with the wound in the soft 
tissues as indicated by the dotted line, A A. Using Luer's 
forceps as a curette detach all vestiges of the neck ligament 
from the base of the occiput and leave the bone bare and 
smooth. If the Luer or ronguer forceps are not available 
the grooving of the occiput may be accomplished with a 
strong curved bone gouge. Be careful to avoid penetrating 
the cranial cavity or the occipito-atloid articulation. Con- 
trol the hemorrhage, cleanse and disinfect the wound, pack 
with iodoform gauze and suture for its entire length except 
the anterior part, where the tampon should slightly pro- 
trude, and dust the margin of the wound with iodoform 
and tannin. Remove the tampon after forty-eight hours 
and dress antiseptically daily. The sutures may or may 
not be removed according to conditions. In carrying out 
this operation our chief aim should be to remove all diseased 
parts, to afford perfect drainage anteriorly, to secure and 
maintain antisepsis, and to keep the wound directly on the 
median line from which no visible scar will result. 



7. LIGATION OF THE PAROTID DUCT. 
Plate IX. 

Objects. The destruction of the parotid gland in case of 
fistula from wounds or abscesses. 

Instruments. Razor, convex scalpel, straight probe- 
pointed scalpel, tenaculum forceps, ligation forceps, tenacula 
needle holder, probe, suture and dressing material. 

Technic. In case of salivary fistula insert a probe 
through it into the duct toward the gland and with 



Pi. ATE IX. 

lylGATlON OF THE PAROTID DuCT. 

Pig, I. Segment of the left ramus of the in- 
ferior maxilla of the horse seen from the right 
and beneath, sp, usual operative field ; a, ex- 
ternal maxillary artery ; v, external maxillary 
vein ; st, st, parotid duct 

Fig. 2. Life size of operation field aXsp, fig. i; 
a, external maxillary artery ; v, external maxil- 
lary vein ; st, parotid duct ; ;//, masseter muscle. 



LIGATION OF THE PAROTID DUCT. 49 

a sharp scalpel lay it free for a distance of from i to 2 cm. 
on the glandular side of the fistulous opening. If the 
fistula has its location on the side of the cheek, cast the 
horse and shave and disinfect the region on the inferior 
maxilla where the artery, vein and parotid duct turn around 
its inferior border. When the operator glides his finger 
over the vascular region from before backward there is felt 
a resistant cord, the external maxillary artery about 3 mm, 
in diameter, pulsating in the living animal. Between this 
and the oral border of the masseter muscle make an incision 
about 4 cm. long parallel with the artery through the skin 
and skin muscle. This incision is more readily made by 
gathering up a fold of skin about 2 cm. high and cutting 
through it. Pick up the loose connective tissue with a pair 
of forceps and excise it. Immediatel}^ behind the external 
maxillary artery, a, Figs, I and II, Plate IX, is the ex- 
ternal maxillary vein, v, and behind this and immediately 
on the border of the masseter muscle lies the parotid duct, 
st. In case of salivary calculi which cannot be removed 
through the mouth and cystic dilation of the parotid duct, 
make the cutaneous incision at the affected point, open the 
canal, and after the removal of the calculus, etc., close the 
duct wound by means of intestinal sutures in such a way 
that the external surfaces of the lips of the wound in the 
wall of the duct are brought in contact, or ligate the duct 
on the proximal side of the point of operation. Ligation is 
accomplished by passing a strong silk thread behind the 
duct by means ^ of a curved aneurism needle carrying the 
ligature around it and tying with a surgeon's knot. The 
parotid duct can also be previously split and an internal 
wound made at the point of ligation. Close the skin 
wound by means of a continuous suture and cover the 
operative surface with iodoform collodion or with wound 
gelatine. 



50 EN TR OPIUM OPERA TION. 

8. ENTROPIUM OPERATION. 

Instruments, Razor, convex scalpel, tenaculum and 
ligation forceps, tenacula, needle holder, needles, thread, 
absorbent cotton. 

Technic. Quiet adult horses may be operated upon in 
the standing position with the aid of local anaesthesia, other 
horses and small animals should be secured in lateral re- 
cumbency preferabl}^ upon the operating table. Shave and 
disinfect the skin of the inverted e^^elid. Grasp the skin of 
the eyelid midwaj^ between the inner and outer canthi 
either with the fingers or the forceps and elevate a skin fold 
parallel with the border of the eyelid to such a height that 
the inverted member assumes its normal position. Pass 




Fig. I. 
Entropium operation on the superior and inferior eyelids of the dog. 

one finger into the conjunctival sac to make sure that the 
conjunctiva is not drawn into the skin fold. Clip the fold 
off with the scissors immediately below the forceps, remov- 
ing an oblong piece. Between the border of the eyelid and 
that of the wound the skin should be left intact for at 
least .5 cm. Ligate any bleeding vessels and close the 
wound by means of interrupted sutures. The wound 
may be covered with iodoform collodion or wound gelatine 
or dusted over with iodoform-tannin. It is usually un- 
necessary and inadvisable to cover the parts with hood or 
other appliance since so long as the wound is healing 
properly the animal will not disturb it. 



STAPHYLOTOMY. 51 

9. STAPHYLOTOMY. 

Object. An operation devised by Dr. M. H. McKillip 
for making a manual exploration of the Eustachian tubes, 
guttural pouches, larjnix, pharynx and posterior nares ; and 
for operations upon these structures. The form and extent 
of the soft palate of the horse is such as to render it ex- 
tremely difficult to make a manual exploration of the parts 
above and behind it, and impossible to make a visual ex- 
amination except with the aid of the expensive and compli- 
cated rhino-laryngoscope, which only aids in diagnosis while 
staph^dotomy combines with this operative advantages, per- 
mitting the free introduction of the hand into the laryngo- 
pharyngeal region. 

Instruments. Mouth speculum, short curved probe 
pointed bistoury with a ring to fit the middle finger. 

Technic. Cast the patient or secure on the operating 
table in lateral recumbency and turn the nose upward. 
Adjust the mouth speculum and open the mouth as wide as 
possible ; draw the tongue well out with the left hand while 
the right carrying the knife on the middle finger is passed 
carefully through the fauces until it hooks over the posterior 
border of the soft palate. The knife is then gently drawn 
forward making an incision along the median line of the 
soft palate from its posterior, free border to its attachment 
on the palatine bone. The hand is then withdrawn and the 
speculum removed for a few minutes to permit the patient to 
rid its pharynx^ of any blood clots or mucus that may have 
accumulated. Readjusting the speculum as before, the 
right hand is again passed through the fauces and now that 
the palate is divided a digital exploration may perfectl}^ re- 
veal the presence of any abnormality in the region. 



Plate X. 

Trifaciai. Neurotomy. 

LIv, Levator labii superioris proprii muscle ; 
lOF, infra-orbital foramen ; NF, superior max- 
illary division of the trifacial nerve. 



TRIFACIAL NEUROTOMY. 55 

lo. TRIFACIAL NEUROTOMY. 
Plate X. 

Object. The relief of involuntary shaking of the head. 

Instruments. Razor, .scissors, convex scalpel, tenacula, 
aneurism needle, compression artery forceps, needles, thread, 
absorbent cotton, a strong piece of muslin 12 cm. square, 

Technic. Secure in lateral recumbency, preferabh^ upon 
the operating table, and produce complete anaesthesia. Re- 
move the halter, bridle, or other head gear. Shave and 
disinfect an area 8 to 10 cm. square over the infra-orbital 
foramen. Locate by touch the infra-orbital foramen, I OF, 
Plate X, below the levator labii superioris proprius muscle 
and displace this slightly upward toward the median line of 
the nose until the foramen can be clearly felt below the 
muscle. With the scalpel begin an incision somewhat 
superior to the foramen and near its nasal border and make 
a w^ound downward and forward in the direction of the 
commisure of the lips about 5 cm. long through the skin, 
muscle and connective tissue down to the nerve and control 
hemorrhage with the greatest care. If the larger branches 
of the glosso-facial vessels are severed they should be ligated 
or twisted. Some times it may be well to ligate these 
vessels prior to making the incision. 

Hold the lips of the wound apart with two tenacula, disect 
away the connective tissue from the nerve until every part 
of it is clearly in view. Pass an aneurism needle beneath 
the nerve trunk and lifting it from the bone make a search 
for a small arter}^ which usually passes along beneath it 
through the foramen and if this can be found either ligate 
it immediately at its point of emergence and again 5 cm. 
lower down and divide between the two ligatures or sepa- 
rating it from the nerve protect carefully against injury. 
With a probe-pointed bistoury or scissors .sever the nerve at 
the foramen and grasping the distal end disect away about 
5 cm. of the trunk and excise. Be very careful to include 
all branches and especially one or two superior or dorsal 



56 TRIFACIAL NEUROTOMY. 

twigs which are directed upward near the foramen. After 
the hemorrhage has been brought under complete control 
and all blood clots have been removed cleanse the wound 
carefully and dust over with iodoform and close with con- 
tinuous sutures. Owing to the great difficulty of securing 
complete asepsis, it may be better in some cases to not suture 
but to insert instead an antiseptic tampon retained by sut- 
ures for 24 hrs. after which remove and dress the wound 
antiseptically 2 or 3 times daily. In order to protect this 
first wound during the operation upon the other side take 
the piece of muslin mentioned among the needs for the 
operation, and folding it several times in a square, place it 
over the wound and suture it firmly at each corner. Turn 
the animal to the opposite side and repeat the operation on 
the other nerve except the application of the square piece 
of muslin which is here unnecessary. As soon as the animal 
stands, remove the protective piece of muslin from the first 
wound, disinfect both, dust them over with iodoform and 
tannin or cover with wound gelatine and leave undisturbed 
to heal by primary union. Avoid halter, bridle or other 
fixtures which might injure the wounds after the operation. 

Dangers. The chief danger in the operation is from in- 
fection, which sets up a severe neuritis in the proximal end 
of the nerve, aggravates the symptoms and causes much 
suffering. In order to prevent infection the aseptic precau- 
tions need be unusually strict in ever}^ detail and the anaes- 
thesia profound. Carefully avoid wounding the neighbor- 
ing vessels and control completel}^ any hemorrhage that 
occurs in order to avoid a hematom in the wound, which 
would invite infection. 

Literature. Involuntary twitching of the head relieved 
by trifacial neurectomy. W. L. Williams, Jour. Comp. 
Med. and V. A., vol. XVIII, p. 426. Involuntary shaking 
of the head and its treatment by trifacial neurectomy, do. 
Am. Vet. Rev., vol. XXIII, p. 321 and CEst. Monatsch. 
Thierheilkunde, Bd. XXIV, 3. 211. 



II. OPERATIONS ON THE NECK. 
II. OPENING OF THE GUTTURAL POUCHES. 

Pirate XI. 

Instruments. Razor, scissors, convex pointed and 
straight probe pointed scalpels, artery forceps, tenacula, 
probe, trocar, curette, drainage tubing, suture and dressing 
material. 

Technic. I. Viborg' s method. The operation is possible 
on the standing animal, but generall}- the patient must be 
cast or placed on the operating table and secured in lateral 
decubitis with the head extended. By extending the head 
and compressing the jugular vein there is brought out the 
triangle immediately behind the posterior border of the in- 
ferior maxilla and below the parotid gland comprised be- 
tween the posterior angle of the inferior maxilla, the terminal 
tendon of the sterno-maxillaris muscle and the external 
maxillary vein. In this so-called Viborg's triangle after the 
removal of the hair and the disinfection of the skin which 
is maintained stretched, make a 5 cm. long incision through 
the skin and skin muscle immediately beneath the afore- 
mentioned tendon and parallel to it. In case of pronounced 
swelling in Viborg's triangle the operator must determine 
the location for the incision by the position of the sterno- 
maxillaris muscle. The skin and subcutem having been 
incised to a sufficient extent, force a passage with the finger 
or with probe pointed scissors closed or other blunt instru- 
ment through the loose connective tissue on the median side 
of the parotid gland, to the guttural pouch and penetrate it 
at its lowest point with the finger or trocar. In order to 
open the empty guttural pouch it is desirable to grasp a 
portion of its wall by means of forceps. Through the 
operative wound a drainage tube can be introduced into the 
pouch, and fixed in its position by sutures. The opening 



PI.ATE XI. 

Opening of the Gutturai. Pouches (Hyo- 

yertebrotomy) According to Viborg 

AND Chabert. 

Head and neck of recumbent horse viewed 
from the side. 5w, Stylo maxillaris muscle ;/>, 
parotid gland ; /, guttural pouch ; k, larynx ; 
st, sterno-maxillaris muscle ; r, rectus capitus 
anticus major muscle ; c. external carotid artery ; 
e, external maxillary artery ; z, internal maxil- 
lary artery ; z/, external maxillary vein ; 5, 
probe ; a, wing of atlas. 



OPENING OF THE GUTTURAL POUCHES. 6i 

can be enlarged in an anter-posterior direction to the extent 
of 5 to 8 cm. or large enough to admit the operator's hand. 

A far more common operation in veterinary practice 
than the opening of the guttural pouches, is the opening of 
abscesses of the sub-parotid lymph glands, lying between the 
inner face of the parotid and the external face of the guttural 
pouch. The operation here used is the same as Viborg's 
for the guttural pouch but does not penetrate that cavity 
because the inner wall of the abscess has pushed the ex- 
ternal wall of the pouch inward so that the former largely 
occupies the usual location of the latter. The d3^spnoea 
generally prohibits casting the animal and necessitates 
operating in the standing position. In some cases the 
dyspnoea is so severe as to demand tracheotomy before the 
opening of the abscess can be undertaken because the ex- 
citement aggravates the difficult respiration to the point of 
suffocation. 

II. ChaberV s method. Secure the horse in the lateral re- 
cumbent position, remove the hair and disinfect the skin 
beneath the wing of the atlas. Make an incision about i 
cm. in front of the lower half of the wing of the atlas and 
parallel to it, about 6 cm. long extending through the skin 
and skin muscle down to the parotid gland. The incision 
is facilitated by rendering the skin tense with the left hand 
and care is to be taken not to wound the auricular nerve 
which passes directly along the atlas. Then draw backward 
the posterior lip of the wound and separate with blunt in- 
struments the posterior border of the parotid gland from 
the atlas, to which it is bound by loose connective tissue, 
and draw it forward with tenacula. At the bottom of the 
opening thus formed there is seen the stylo-maxillaris 
muscle, sm, Plate XI, lying against the median side of 
the parotid gland covered only by the aponeurosis of the 
mastoido-humeralis muscle. With the handle of the scalpel 
inclined toward the wing of the atlas penetrate in the 



62 OPENING OF THE GUTTURAL POUCHES. 

direction of their fibers the aponeurotic expansion of the 
mastoido-humeraUs, and the stylo-maxillaris muscle. The 
puncture is thus located between the ninth and tenth 
nerves on one side and the internal carotid on the other. 
Since the wall of the guttural pouch rests against the median 
side of the digastricus muscle it is opened b}^ this incision. 
The operator inserts an index finger along the blade of the 
knife at first and then withdrawing the instrument passes 
the other index finger also in the penetrant wound and by 
forcibly parting these, dilates it. The abnormal contents are 
then removed by means of forceps, curetting and irrigation. 
In order to prevent adhesion of the wound lips in the firmly 
stretched st3do-maxillaris muscle, introduce a strong drain- 
age tube into the pouch and fix it to the external borders of 
the wound by a suture. 

III. Dideridi' s method. This combines the operations 
under I and II, with the difference that the superior opening 
of the pouch is made immediatel}" behind the stvlo-maxillaris. 
In order to accomplish this the cutaneous wound over the 
wnng of the atlas must be prolonged below it. After detach- 
ing the posterior border of the parotid gland the operator 
searches in the loose areolar tissue with the index finger of 
the left hand for the vascular angle which is formed b}^ the 
occipital, internal carotid and external carotid arteries which 
may be detected by pulsation — the same is located at a depth 
of somewhere from 8 to lo cm. Place the volar surface of 
the finger in the vascular angle and push a sharp scalpel 
along its dorsal side to the pouch which here becomes 
opened on its posterior lateral surface. 

This method has the advantage over Chabert's that for 
the removal of hard contents (chondroid) the opening can 
be readily dilated, even to such an extent that the entire 
hand can be passed into the air sac and the opening of the 
Kustachian tube be exolored. 



TRACHEOTOMY. 63 

12. TRACHEOrOMY. 

Fig. 2. 

Instruments. Razor, scissors, convex scalpel, tenacula, 
tenaculum and ligation forceps, trachea tube, and suture 
material. 

Technic. In the superior third of the cervical region, 
in the neighborhood of the fourth to the sixth tracheal ring, 
shave and disinfect the skin on the anterior surface of the 
neck to the extent of 10 cm. long by 5 cm. wide. The 
operation is best performed upon the standing animal with 
the head extended. In lateral decubitis of the horse the 
operation is carried out with some difficulty, and generally 
the operator fails to get the incision on the median line. 




Fig. 2. 

Tracheotomy. 5, stern o-thyro-hyoideus muscle ; /, trachea ; 
sch, mucous membrane of the posterior wall of the trachea ; 
/, interannular ligament. 

The operator stands before the right shoulder of the horse 
with an assistant opposite him. 

Make the incision by rendering the skin tense along the 
median line of the trachea with the left hand and then mak- 
ing a drawing cut from above to below with the scalpel. 
After the skin muscle is cut through, in order to avoid hem- 



64 TRACHEOTOMY. 

orrhage, separate the two sterno-thyro-hyoideus muscles by 
means of tenacula along the median line in the white strip 
of connective tissue. The opening into the trachea may be 
made in a variety of ways. The quickest and most crude 
method is to slit it from above downwards through three or 
four tracheal rings, and pressing the severed ends apart 
insert the tube through the opening. Since the tracheal 
rings are incomplete, being open on their dorsal surfaces, 
cutting through the ventral portion divides each ring into 
two separate parts and their being pushed apart, distorts 
them and tends to the causation of chondritis and collapse 
of the trachea, a danger which increases with the duration 
of time that the tube is maintained in position. It is there- 
fore most suitable for hurried operation in impending 
suffocation where the tube will probably be needed for a 
short time only. 

A second method of operation, illustrated in Fig. 2, con- 
sists in making a transverse incision through the inter-annu- 
lar ligament between the two last exposed tracheal rings the 
length of the diameter of the tube to be inserted. Make 
a perpendicular incision upward from each end of this at a 
point I to 1.5 cm. from the median line through one or two 
tracheal rings, according to the size of the tube. With 
forceps or tenaculum grasp the segments of partially de- 
tached cartilage and remove them by cutting through the 
inter-annular ligament. 

A third and to us preferable method is to insert a narrow 
bladed scalpel transversely at about the lower third of the 
lowermost bared tracheal ring and cutting outwards and 
upwards in a curved line, pass through the first inter-annu- 
lar ligament and continue into the succeeding segment until 
near its superior border, when the incision is curved down- 
ward to eventuall}^ reach the starting point, the isolated 
section of the trachea being securely grasped with a pair of 
forceps before its excision is completed. By this method 
no tracheal ring is severed. 



ARYTENECTONOMY. 65 

The trachea tube is to be removed and cleansed daily as 
long as its use is necessary, and when discontinued the 
wound should be left open and dressed antiseptically. 



13. ARYTKNECTOMY. 
PIRATE XII. 

Object. The relief of roaring or laryiiigismits paralyticus . 

Instrumenst. Razor, scissors, scalpel, razor shaped 
knife with long handle, long curved scissors, long curved 
uterine dressing forceps, double tenaculum forceps, trachea 
tube, retractors, reflecting lamp, absorbent cotton and dress- 
ing material. 

Technic. Perform tracheotoni}^ as advised in preced- 
ing chapter. Secure the animal in lateral recumbency 
preferably upon the operating table and induce complete 
anaesthesia closing the trachea tube in the meantime or 
administering the chloroform through this by means of a 
bent funnel while the nostrils are occluded b}' tampons. 
Shave and disinfect the skin over the laryngeal region. 
Place the animal upon its back with the head extended and 
remove the halter or other head gear. If necessary continue 
the adminstration of chloroform through the trachea tube 
by means of a funnel the small end of which is inserted in 
it while the chloroform is dropped on a towel spread over 
the larger end. The operator takes his place on the right 
side of the animal and the assistant on the left. Make a 
longitudinal incision through the skin and subcutem be- 
ginning at the anterior part of the thyroid cartilage and ex- 
tending backward on the median line of the 3rd. or 4th. 
tracheal ring. Control the cutaneous hemorrhage. Con- 
tinue the incision through the subjacent muscular tissue 
being careful to follow the median line exactly until the 
crico-thyroidean ligament, CTL, Plate XII, the cricoid 
cartilage C, and the first tracheal ring TRI, are laid bare. 

5 



PI.ATE XII. 

Arytenectomy. 

E, epiglottis ; TT, thyroid cartilage ; CC, 
cricoid cartilage ; TRI, first tracheal ring ; V. 
left vocal cord ; A, left arytenoid cartilage sur- 
rounded by dotted line of incision ; CTC, crico- 
thyro'ideau ligament. 



c--, 



TRl 




ARYTENECTOMY. 69 

Again control anj^ hemorrhage. Phmge the scalpel with 
its cutting edge directed backward through the crico- 
th3'roidean ligament on a level with the dotted line T and 
extend this backward along the median line severing the 
cricoid cartilage, C, and the first tracheal ring, TRI. In- 
sert the retractors and have the larynx held well open by as- 
sistants. Illuminate the larynx by means of a reflecting 
lamp as may be required. After controlling any hemor- 
rhage caused b}^ the foregoing make an incision through 
the mucosa and the intervening connective tissue between 
the two arytenoid cartilages, A, beginning at the anterior 
part and extending backward to the cricoid, thence turn- 
ing upward and laterally, incise the mucosa across the 
posterior end of the arytenoid thence forward along its 
lateral border through the vocal cord, V, and turning down- 
ward as the animal lies, that is toward the dorsal part of 
the larynx, continue the incision to the point of beginning. 
In making this incision cut as closely as possible to the 
margin of the cartilage so that a minimum amount of the 
mucous membrane will be removed. Grasp the lateral 
border of the cartilage with the long tenaculum forceps and 
with a razor-shaped knife or the scissors separate the lateral 
and anterior portions of it from the adjacent tissues keep- 
ing always immediately against it in order to produce as 
clean a wound as possible and to avoid injuring adjacent 
vessels from which hemorrhage would occur. 

When the cartilage has been detached over the greater part 
of its surface locate the crico-arytenoid articulation and dis- 
articulate or cut through the arytenoid as close to the articu- 
lation as possible with the razor-shaped knife or the scLssors. 
Remove all blood by means of pledgets of absorbent cotton 
securely held in the long dressing forceps, or the clots may 
be pushed into. the pharynx when they will generally be 
swallowed. Carefully remove an}- cartilaginous remnants 
or tissue shreds and control the hemorrhage from any 



70 ROARING OPERATION. 

visible vessels. Dust the wounds thoroughly with iodoform 
and tannin and if the capillary hemorrhage is great pack 
the larynx with a single strip of iodoform gauze and secure 
it by sutures through the margin of the skin wound. Re- 
move this tampon after twelve to twenty, four hours. Wash 
and disinfect the wounds daily. 

Remove the trachea tube daily and cleanse, and retain it 
in position for 6 to lo days or until the animal breathes 
freely without it. After about 8 days insert the retractors 
in the laryngeal wound, dilate it, examine the interior 
with the aid of a lamp and give any needed attention to 
unhealthy granulations or other untoward conditions. 



14. ROARING OPERATION BY EXCISION OF THE VOCAL 
CORDS AND VENTRICLE OF THE LARYNX. 

Pr.ATE XIII 

Objects. The same as in the preceding operation except 
that we attempt to relieve roaring by causing the arytenoid 
cartilage to become fixed against the side of the glottis b}^ 
cicatricial adhesion. 

Instruments. Same as in the preceding. 

Technic. The technic of this operation is identical with 
the preceding until the larynx has been been opened. 
Grasp the left vocal cord with the double tenaculum for- 
ceps, one jaw of which rests in the ventricle and lift it up- 
wards until the parts are rendered tense. With the razor 
shaped scalpel make an incision parallel with the long axis 
of the vocal cord on the tracheal side of it through the mu- 
cous membrane and cord and continue this incision forward 
internally along the immediate border of the arytenoid car- 
tilage barely through the mucous membrane and laterally 
make a similar cut directed forwards approximately i to 
i}^ cm. distant from the preceding as indicated by the 
dotted line in Fig. i, Pla,te XIII. Keeping the parts in- 



ROARING OPERATION. 71 

eluded in the tenaculum forceps tense, dissect the vocal 
cord and mucous membrane from the underl3nng parts 
from behind forward toward the apex of the arytenoid car- 
tilage and continue the two incisions forward until the ven- 
tricle has been passed when the}^ are made to converge and 
finally meet, thus isolating completeh^ the mucous mem- 
brane of that depression. Should the tension upon the 
vocal cord and mucous membrane by means of the tenac- 
ulum forceps be too great thej^ may tear asunder in which 
case the remnants must be grasped by means of the tenac- 
ulum forceps or better with the long dressing forceps and 
the operation continued. The mucous membrane should 
be carefully trimmed around the margin of the wound and 
care should be taken to not remove entirely the remnants 
of the wasted thyro-arytenoideus muscle because that tends 
to permit the cartilage to drop down too low in the larynx 
nor. should the incision in the ventricle be carried deeper 
than the mucous membrane lest we wound important ves- 
sels and produce annoying hemorrhages. Remove all blood 
clots and disinfect the parts. Apply no sutures to the 
wound in the vocal cords, mucosa or larynx. After the 
animal has recovered from the anaesthesia, cleanse the ex- 
ternal wound carefully and wash it daily with an antiseptic 
and if thought best apply this also to the wound in the vo- 
cal cord b}^ means of saturated absorbent cotton grasped 
with the long dressing forceps and pushed up to the area 
through the laryngeal incision. Cleanse the trachea tube 
daily and keep in position from six to ten days or longer, 
should the animal show difficult}^ in breathing when it is 
removed. 



PI.ATE XIII. 

Operation for Rkuef of Roaring. 

Fig. I. Longitudinal section through the 
ventricleof the larynx ; A, Arytenoid cartilage; 
TA, Anterior fasiculus of thyro-arytenoideus 
muscle ; TA^, Posterior bundle thyro-arytenoid- 
eus ; VC, vocal cords ; V, Laryngeal ventri- 
cle ; T, Thyroid cartilage ; E, Epiglottis. 

Fig. 2. Sagittal section of the larynx. C, 
cricoid cartilage ; C-T, crico-thyroidean liga- 
ment. Other lettering same as Fig. i. 




Fig I 





Fig. 2. 



INTRA-TRACHEAL IRRIGATION. 75 

15. INTRA-TRACHEAL IRRIGATION. 

Objects. The washing of irritant or septic substances 
from, and the disinfection of, the trachea and bronchi. 

Instruments. Same as for tracheotomy, and a gravity 
irrigating apparatus fitted with 3 m. of rubber tubing about 
I cm. in diameter, 5 Hters of .6 percent, soda chloride solu- 
tion at a temperature of 37 to 39° C. 

Technic. Operate on the standing animal. Perform 
tracheotomy. Elevate the gravity apparatus containing the 
irrigating fluid i to 2 m. above the patient, have the 
animal's head sHghtly elevated, insert the free end of the 
rubber hose in the trachea tube and let the fluid flow into 
the trachea in a moderate stream until it is filled and the 
animal makes expulsive efforts, when the inflow is stopped 
and the animal permitted to lower his head and expel the 
fluid, then raise the head again and repeat until the fluid is 
expelled clear. Repeat the operation according to require- 
ment. In cases of suppurative bronchitis, peroxide of 
hydrogen may be added to the solution. 



16. INTRAVENOUS INJECTION. 
Fig. 3. 

Instruments. Scissors, hypodermic S3^ringe. 

Technic. The operation is performed on the standing 
animal on either jugular vein at about the juncture of the 
upper and middle thirds of the neck ; to most operators the 
right jugular is the more convenient. At the place desig- 
nated the subscapulo-hyoideus muscle lies between the 
jugular vein and the carotid artery. After clipping the hair, 
the skin should be carefully disinfected. The vein lies in 
the jugular groove between the mastoido-humeralis and the 
sterno-maxrllaris muscles covered only by the skin and skin 
muscle. Stand by the shoulder of the horse and compress 
the jugular with the thumb as shown in Figure 3 or with the 



76 



INTRAVENOUS INJECTION. 



second to the fourth fingers, in which case the ball of the 
thumb rests on the mastoido-humeralis muscle, in a wa}^ that 
the vein becomes filled above the point of compression in the 
shorn area and stands out as a swollen cord. In the case 
of fleshy necked horses this compression is more readily 
attained if the htad is somewhat elevated and extended by an 
assistant. If the vein can not be made prominent in this 




Fig 3. Intravenous Injeclion. 

wa}^ the compression should be alternatel}' applied and with- 
drawn suddenly, the course of the vein then reveals itself by 
a wave-like movement along the jugular groove. Just 
above the point of compression the vein is the most fully 
distended and firmly fixed. After testing the hypodermic 
needle to see that it is open hold it between the second and 
third fingers while the thumb covers its basal opening and 
thrust it through the skin, cutaneous muscle and jugular 
wall, in the direction of the vein obliquely forwards and up- 
wards I to 2 cm. deep, so that the point of the needle enters 
the vessel at its most distended part. In this way it is easy 
to prevent injury to the median wall of the vein. If the 



PHLEBOTOMY. 77 

vein has been properly punctured blood will flow from the 
needle upon the removal of the thumb. If the vein is not 
entered at the first attempt the needle should be partly with- 
drawn and then pushed in again in a slightly different direc- 
tion. The compression is then removed and the hypo- 
dermic syringe in which no air is contained is connected 
and the contents slowly discharged into the vein. In with- 
drawing the needle be careful to press the skin firmly against 
the underlying part. The omission of this precaution fre- 
quently results in the formation of a subcutaneous hema- 
tome. 



17. PHLEBOTOMY. 
Fig. 3. 

Instruments. Razor or scissors, fleams, lancet, phle- 
botomy trocar, spring lancet, pins, suture material. 

Technic. a. Phlebotomy zvith fleams may be performed 
on either jugular vein. The operation is preferably carried 
out on the standing animal, but is not difficult when the 
patient is recumbent. The point of operation is at about 
the boundary line between the upper and middle cervical 
regions, because it is here that the subscapulo-hyoideus 
muscle which separates the jugular vein from the carotid 
artery is most voluminous and consequently affords the 
greatest protection to the latter. At this point clip or shave 
and disinfect the skin. Grasp the extended blade of the 
fleam at the joint with the thumb and index finger of one 
hand, whiles the third and fourth fingers compress the 
jugular vein at a point far enough below the shaved part 
that the fleam blade rests upon it. In fleshy-necked 
animals the course of the vein may be clearly made out by 
causing its repeated distension and relaxation. It is well 
to be careful that the point of the fleam blade is not allowed 
to prick the skin prematurely and render the animal rest- 



78 PHLEBOTOMY. 

less, and that it is held perpendicular to the surface and 
parallel to the long axis of the vein. The most elevated 
point of the vessel should be struck b}' the blade in such a 
way that the skin, subcutaneous muscle and jugular wall 
are penetrated parallel to the long axis of the vessel. Drive 
the fleam blade into the vein by a short, sharp blow with a 
small stick of heavy wood. The extension on the fleam 
blade prevents its being driven too deeply. The size of 
the blade to be used depends upon the thickness of the skin 
and other tissues covering the vein. If the vein is opened, 
dark red blood escapes from the wound in a large stream. 
If the operation does not succeed at the first effort, one 
should select an undamaged portion of the skin for a second 
attempt so that the opening into the vein may be direct and 
clean. When the vein is opened lay the instrument aside, 
the compression of the vessel being continued in order to 
prevent aspiration of air into it and also that the lips of the 
skin wound shall not become displaced in relation to that 
of the vein by which the escape of blood would be impeded 
or stopped. The flow of blood ma}^ be favored by inducing 
masticatory movements by the animal. The amount of 
blood withdrawn varies between 3 and 8 liters, according 
to size of the animal and the object to be attained. The 
wound may be closed by an interrupted or a pinned suture. 
For the latter, relieve the compression on the vein aiid 
grasp the lips of the skin wound between the finger and 
thumb and stick the pin perpendicularly through the middle 
of it a few mm. from its borders. Apply a noose of silk 
ligature previously prepared over the pin and close and tie 
the loop. In applying the pin and loop, take care not to 
devate the skin from the underlying part, which tends to 
the production of a hematome. 

b. With the lancet the operation is preferably performed 
on the right side of the neck. Compress the vein as illus- 
trated in Fig. 3, and hold the lancet between the thumb and 



LIGATION OF THE CAROTID ARTERY. 79 

index finger in such a manner that it can only penetrate as 
far as into the vein, and then push it in quickl}^ just in 
front of the compressing thumb through the skin, subcutem 
and venous wall as deep as the fingers holding the lancet 
will permit. 

Hold the blade perpendicular to the long axis of the 
vein, and avoid directing the point dorsalwards, which would 
endanger the superior wall of the vessel or cause the 
lancet to glide over the wall and not enter the vein. When 
the lancet has entered the vein, extend the wound somewhat 
toward the head by flexing the hand dorsally. In cattle it 
is necessar}^ to compress the vein b}^ means of a cord tightlj^ 
drawn around the neck, the operator taking the same posi- 
tion as in the horse while an assistant holds the animal by 
the horns or nose. Close the wound as in a. 

Phlebotomy with the spring lancet is carried out in a sim- 
ilar manner, the jugular being compressed in the same way, 
and the lancet, with the spring set, placed over the vein in 
such a way that the opening will be made in the same direc- 
tion and manner as with the fleams. The lancet blade is 
then released and penetrates the vein. The compression be- 
low is continued as in other cases. 

c. Phlebotomy zvith the tiocar is performed in the same 
manner as has been described for intravenous injection. So 
long as the flow of blood continues the compression of the 
vein must not be intermitted. The phlebotomy trocar 
should be about 5 mm. in diameter. 



18. LIGATION OF THE CAROTID ARTERY. 
PI.ATE XIV. 

Objects. The control of hemorrhage from wounds or 
the prevention of hemorrhage during the removal of tumors 
or other operations iu the parotid region. 

Instruments. Scissors, scalpel, tenacula, aneurism 



Pirate XIV. 

Fig. I. — a, Ligation of the common 
carotid artery ; b, CBsophagotomy. 

Fig. 2. — Ligation of the common 
carotid artery, ^.common carotid artery ; 
7, jugular vein ; v, vagus nerve ; s, 
sympathetic nerve ; r^ recurrent nerve; 
/>, cervical pauniculouscarnosus muscle; 
in, sternomaxillaris muscle ; st, levator 
humeri muscle. 

Fig. 3. — O^sophagotomv. c, com- 
mon carotid artery;/, jugular vein; 
0, o\ oesophagus ; s, sympathetic 
nerve ; t, trachea ; st, mastoido hum- 
eralis (lavator humeri) muscle. 




Fig. I. 



LIGATION OF THE CAROTID ARTERY, 83 

needle, mouse-toothed forceps, ligation forceps, suture 
material. 

Technic. The operation is possible on the standing 
animal with the aid of cocaine or other local anaesthetic but 
it is preferable to confine the patient in lateral recumbency 
and anaesthetize. 

The operatioD is made at the same point as for phlebotomy 
and the same cutaneous wound, a, Plate XIV, ma}^ be used 
for this purpose. The incision should be at least 10 cm. 
long extending through the skin, flesh}' panniculus and 
subscapulo-hyoideus muscles and then a passage forced with 
the fingers, to the trachea. At the region of the neck 
indicated, the carotid passes along the border between the 
lateral and dorsal surfaces of the trachea, accompanied 
dorsalh' b}- the vagus and sympathetic nerves and ventrally 
b}' the recurrent. (In Figure 2, Plate XIV, the vagus 
and sympathetic nerves, v and s, are pushed out of their 
normal position and appear ventrally to the carotid.) Pass 
the index finger over and behind the carotid until the 
trachea is reached, and encircling the inner and lower sides 
of the arter}^ force a way through the surrounding areolar 
tissue and draw the vessel out through the wound. As a 
rule the carotid is still loosely surrounded by connective 
tissue, which comes from the deep fascia of the neck and in 
which also the three above mentioned nerves are found. 
These nerves must be carefuU}- separated from the carotid 
and must on no account be included in the ligature. Ligate 
the carotid twiqe with an interval of about 2 cm. between 
the two ligatures and divide the artery midwa}^ between 
them. The second ligature is necessary in order to prevent 
hemorrhage from the distal end through collateral anasto- 
moses and it is essential to sever the arter}' in order to avoid 
its rupture by the stretching of the undivided carotid dur- 
ing movements of the neck where the nutrition has been cut 
off at the point of ligation. Provide drainage for the wound 
and suture the muscle and skin. 



84 CESOPHAGOTOMY. 



19. ce:sophagotomy. 

PlvATE XIV. 

Instruments. Razor, scissors, convex scalpel, straight 
probe-pointed bistour}^, tenacula, artery forceps, absorbent 
cotton, suture material. 

Technic. The operation can be carried out on the 
standing or the recumbent animal. At its origin the 
oesophagus lies above the trachea somewhat to the left of 
the median line and as it descends it gradually deviates 
farther until in the lower cervical region it lies down along 
the side. 

The operation is performed at any point between the 
pharynx and chest where the lodgment of a foreign body 
or other condition may demand it. When the oesophagus 
is empty the operation is best performed in the lower third 
of the neck at b, Figure i, Plate XIV. 

An incision 10 cm. long through the skin and skin muscle 
is made on the left side between the anterior border of the 
mastoido-humeralis muscle and the jugular vein. With the 
two index fingers divide the loose connective tissue down to 
the oesophagus, which lies between the left scalenus muscle, 
trachea and jugular vein. Along the supero-external 
border of the trachea runs the carotid, accompanied dorsally 
by the vagus and sympathetic and ventrally by the re- 
current nerves. The oesophagus feels like a round muscle 
within which one can distinguish a firmer cord, the mucous 
membrane. When brought into view the organ has a pale 
red color, and it, with the trachea is surrounded by the 
deep fascia of the neck. Pass one finger around the 
oesophagus from behind, draw it away from the trachea, 
force a passage through the deep fascia of the neck and 
draw it out through the external wound. After making an 
incision through the muscle and mucous membrane intro- 



(BSOPHAGOTOMY. 85 

duce a probe pointed bistoury or a scissors blade into the 
lumen of the oesophagus and split its wall. The mucous 
membrane is white and lies in thick longitudinal folds. 
When there is a foreign bod}^ in the oesophagus the opera- 
tion is performed at the point where it is lodged in the 
manner described and the incision should be made only 
large enough to permit its removal. In diverticuli of the 
oesophagus an elliptical piece of the mucous membrane 
which has been overstretched is cut out. The oesophageal 
wound is closed by a laminated suture, that is, the mucous 
membrane is united by means of an intestinal suture and 
the muscular wall closed over this. The skin and muscular 
wound may either be left open or closed with the Baj-er 
suture and bandaged with a drainage tube in the lower 
angle. 



III. OPERATIONS ON THE TRUNK AND GENITAL 
ORGANS. 

20. PUNCTURE OF THE CHEST. 
Fig. 4. 

Objects. The relief of hydrothorax or pyothorax. 

Instruments. Razor, scissors, trocar, i m. of rubber 
tubing of the same size as the trocar, vessel for receiving 
the escaping fluid, dressing material. 

Technic. Operate upon the standing animal, the point 
of operation being the seventh intercostal space on the left 
side, and the sixth on the right. Dogs may be laid upon 




Fig. 4. 
Puncture of the ciiest ; puncture of the intestine. 

the table. The anterior ribs are so covered by the shoulder 
that they cannot be counted from before backwards and 
must be enumerated from behind forwards. In the horse 
we estimate eighteen ribs and in the dog fourteen. Count- 
ing II or 12 intercostal spaces from behind we reach the 



PUNCTURE OF THE INTESTINES. 87 

point of operation on the left and right sides respectively. 
Clip or shave the designated intercostal area immediately 
above the thoracic vein. Grasp the trocar firmh^ with the 
thumb and index finger of one hand at such a distance 
from the point as will permit the canula to enter the chest. 
After the skin over the seat of operation has been drawn 
aside by the hand, place the trocar at the anterior border 
of the rib with the point inclined slightly forward and with 
a sharp blow with the palm of the other hand drive the in- 
strument through the skin, cutaneous and intercostal mus- 
cles, internal thoracic fascia and pleura into the pleural sac. 
When the resistance ceases, the thoracic cavity has been 
entered. Remove the stilette and permit the pus, l3'mph, 
or other fluid to escape. This flow is at first continuous, 
but later becomes rythmic, synchronous with respiration. 
The intermission of the flow during inspiration permits air 
to enter the pleural cavit}^ unless precautions are taken 
against it ; this is most readily obviated by slipping one 
end of the rubber tubing over the exposed part of the can- 
ula and placing the other extremity in the receptacle for 
the fluid where it will be submerged. This wiil not only 
prevent aspiration of air into the chest but will act as a 
sj^phon to aid in the withdrawal of the fluid from the pleu- 
ral cavity. In the absence of the tubing the entrance of 
air may be avoided by closing the canula with the finger 
after each expiration. 



21. pqncture; of the intestines. 

Figs. 4, 5. 

Object. The relief of intestinal t3'mpany. 

Instruments. Razor, scissors, trocar. 

Technic. Puncture of the intestine is preferably per- 
formed on the standing horse but may be carried out on the 
recumbent animal. The point of operation is in the right 



88 PUNCTURE OF THE INTESTINES. 

flank about equi-distant from the last rib, the extremities of 
the transverse processes of the himbar vertebrae and the ex- 
ternal angle of the ilium in the standing horse ; at the upper- 
most point of the abdomen in the recumbent animal, that is, 
at the most prominent part of the distension. After the 
skin at this place has been clipped or shaved and disinfected 
grasp the trocar with the index finger and the thumb of the 
left hand and holding the instrument perpendicular to the 
bod}^ surface, give it a firm, quick blow with the palm of 
the right hand and drive it through the abdominal wall into 
the intestine. With a properly constructed trocar of the 
dimensions suggested in Figure 5 no preliminary puncture 
with the lancet is required or advisable. The cutting end 
of the stilette should be very long, tapering and sharp so 
that it will cut as freely as the lancet. By performing the 
operation as directed the trocar ordinarily punctures the 



Fig. 5. 

Intestine trocar with sheath. Outside diameter of canula 3 mm., 
length of canula, 16 cm. 

caecum. Withdraw the stilette and permit the gas to escape 
through the canula. The canula may become occluded by 
particles of ingesta entering it and these should be removed 
by reinserting the stilette. The intestine first punctured 
may collapse and the flow of gas cease while the tympany 
continues in other parts ; this may be overcome by reintro- 
ducing the stilette and pushing the trocar through the distal 
wall of the bowel and into the next section of intestine 
beyond. If this does not succeed the trocar may be with- 
drawn and reinserted in a neighboring area or if need be on 
the opposite side of the animal. In withdrawing the canula 
replace the stilette and press the skin against the abdomen 



SUBCUTANEOUS CAUDAL MYOTOMY, 89 

with the thumb and finger of one hand while the trocar is 
drawn out with the other. This tends to prevent particles 
of ingesta from following the canula out of the intestine and 
becoming lodged at some point in the track of the wound to 
set up inflammatory processes there. Before introduction, 
the trocar should alwa5's be rendered sterile but should not 
bear irritant antiseptics, which becoming lodged in the 
wound tend to irritate the tissues and produce abscesses. 
Puncture of the intestine is so often extremely urgent that 
deliberate aseptic precautions are not always practicable and 
trocarization only too frequently results in abscesses in the 
abdominal wall. Its prevention must depend chiefly upon 
the disinfection of the skin and instrument. It becomes 
important to use an instrument which is clean in advance. 
If the one shown in fig. 5 is well disinfected after using and 
the sheath is filled with alcohol before it is screwed on, the 
instrument will remain sterile until it is again unsheathed 
and then the alcohol will quickl}^ evaporate and leave it 
aseptic. 



22. SUBCUTANEOUS CAUDAI, MYOTOMY. 
Fig. 6. 

Object. The correction of curved tail. 

Instruments. Sharp straight tenotome, bandage. 

Technic. The point or points of curvature and their 
extent are to be caref ull}^ noted by having the animal trotted 
away from the operator. The curvature is generally due to 
unequal development of the two levator or extensor muscles. 
Fig. 6.-6', though quite rarely the depressors, /, may be 
implicated. Confine the animal in stocks, or in default of 
these, control by means of a twitch and sideline. Cleanse and 
disinfect the tail and have it sharply bent by an assistant in 
the opposite" direction to the curvature. Locate the longi- 
tudinal furrow between the levator and depressor muscles on 



90 SUBCUTANEOUS CAUDAL MYOTOMY. 

what has now become the convex side and at the lower margin 
of the levator and just above i\ Fig. 6, insert the tenotome at 
the most prominent part of curvation, the incision being paral- 
lel wath the muscular fibers, and push the instrument entirely 
through the muscle to the vertebra, then turning the cutting 
edge upwards, at the same time advancing the point toward 
the median line, sever the entire muscle. The superior 
lateral caudal artery, s, P'ig. 6, bleeds profusely if severed, 
and wounding of it may usuall}^ be avoided by withdrawing 
the tenotome a trifle in passing that point. Wounding the 




Fig 6. 
Transverse section of the tail, w, caudal vertebra ; c, sacro- 
coccygeus lateralis muscle;^, sacro coccygeus superior;/, 
depressor longus and brevis muscles (sacro-coccygeus infer- 
ior) ; z, intertraiisversales muscles ; a, coccygeal artery ; s, sa- 
pero-lateral coccygeal artery ; /, infero-lateral coccygeal ar- 
tery ; V, caudal veins (dorsal, ventral, lateral) ; sch, caudal 
fascia ; h, skin, 
skin over the muscular incision is avoided by placing 
the thumb of the left hand over the line of incision so 
the knife will be recognized as soon as the muscle and cau- 
dal fascia are cut through. Remove the knife in the same 
manner as introduced. Release the horse and have him 
trotted again. If the operation is sufficient, the tail should curve 
in about the same degree as before, but in the opposite direc- 



CAUDAL MYECTOMY. 91 

Hon. If this has not been attained examine carefully and 
sever any remaining bundles of muscle, and this not suffic- 
ing repeat the operation as before at another point 5 or 6 
cm. above or below the first, severing the muscle again. 
Or if the depressor appears implicated, sever it in a similar 
manner. In extreme cases the entire lateral half of the 
caudal muscles, tendons and aponeurosis may be severed. 
Apply an antiseptic pad to the wound and retain it by a 
moderately firm bandage, which serves at once as an occlu- 
sive dressing and effective hemostatic. Remove the band- 
age after 24 hours. By this plan of operation it is not 
intended to tie the tail to the side of the animal during the 
time of healing but when bandaging it immediately after 
the operation, it should be held away from the side toward 
which it formerly curved so that the bandage would tend to 
prevent the return of the organ to its former position. 



23. CAUDAL MYECTOMY. 
Fig 6 AND Plate XV 

Objects. For the prevention of the gripping of the reins 
by the tail. 

Instruments. Elastic Hgature, straight bistoury, 
tenacula, absorbent cotton, bandages. 

Technic. Confine the animal in lateral decubitis or in 
stocks, cleanse and disinfect the parts and apply the elastic 
ligature as close as possible to the root of the tail. Have 
an assistant hold the tail upwards, z. e., dorsalwards, and 
tightly stretched. Make an incision 15 to 20 cm. long, over 
the middle of the inferior surface of each depressor longus 
muscle, beginning close against the elastic ligature and ex- 
tending toward the apex, severing at once the skin and 
caudal fascia down to the muscle. Let an assistant retract 
the lips of the incision with tenacula while the operator 
dissects the depressor longus muscle, DC, Plate XV, from 



Pr.ATE XV. 

Caudai, Mykctomy To Prevent Gripping 
OF THE Reins. 

DC, Depressor coccygeus longus muscle ; T, 
tourniquet. 



\ 



AMPUTA TION OF THE TAIL. 95 

the adjacent tissues at either side, sever it b}^ a transverse 
incision close against the Hgature and dissect away the en- 
tire muscle down to the lower end of the w^ound and there 
excise it. Repeat the operation on the opposite side. Make 
two elongated tampons of absorbent cotton, of the size and 
form of the muscles removed, saturate these with i-iooo 
sublimate solution, insert neatlv in the wounds and over 
this to aid in securing antisepsis and to equalize the pressure 
apply a pad of absorbent cotton, saturated with sublimate 
solution, covering the wounds and encircling the tail and 
secure by a moderately firm bandage as closely as possible 
to the elastic ligature. Remove the ligature, when hemor- 
rhage may ensue, which is to be controlled by the applica- 
tion of a second bandage extending higher up on the tail. 
Remove the bandage in 24 hours and dress as before for a 
second day after which treat as an open wound. Care should 
be taken to not apply the bandage too tightly or leave it in 
place for more than 24 hours, since otherwise necrosis of 
the tail is liable to occur and necessitate amputation. 



24. AMPUTATION OF THE TAIL 
Plate XVI. 

Objects. The treatment of malignant, or incurable dis- 
eases of the tail. 

Instruments. Elastic bandage, scalpel, razor, artery 
forceps, bone cutting forceps, suture material. 

Technic. The animal may generally be operated upon 
in a standing position secured in the stocks or with the aid 
of the side line. Local anaesthesia may be applied by in- 
jecting cocaine or other drug deeply upon the nerve trunk 
as well as just beneath the skin. The animals' attention 
may be attracted by means of the twitch if found necessary. 
The point of amputation is determined by the location of 



PI.ATE XVI. 

Amputation of Taii.. 

Fig. I. — Tail amputated showing flaps un- 
sutured ; B, Bandage securing hairs turned 
upward out of operator's way. 

Fig. 2 — Operation completed showing su- 
tures ; B, Bandage applied to secure hair of tail 
upwards out of operator's way. 




Fig 




Fig. 2. 



AMPUTATION OF THE TAIL. 99 

the disease. Over the area of operation dip the hair, shave 
and thoroughly disinfect. Apply the tourniquet or elastic 
bandage at the base of the tail so as to render the operation 
bloodless. 

Above the seat of operation turn the hair upward toward 
the root of the tail and secure it there by means of the 
bandage, B, Fig. i. Locate as accurately as possible the 
position of a joint at the point where it is desired to oper- 
ate and with the scalpel begin an incision on the median 
line on the upper side of the organ about i cm. above the 
articulation and carry this obliquely outward for a distance 
of 4 to 6 cm. according to the size of the tail and then con- 
tinue it downward, backward and inward along the side and 
inferior surface until directly opposite to the place of begin- 
ning. Make a similar incision upon the opposite side of the 
tail, cut through all the connective tissue and muscles down 
to the bone and then disarticulate wdth the aid of the scalpel. 
Search for the arteries and control the hemorrhage b}^ 
torsion or ligation. The vessels will be more readily found 
by loosening the tourniquet so as to permit the blood to flow. 

Some operators prefer to begin the incision at the side of 
the tail instead of upon the dorsal surface and in that way 
have a dorsal and ventral flap instead of right and left as 
indicated in Fig. i . The excision having been completed the 
flaps are brought together by means of strong silk or silk 
worm gut sutures as shown in Fig. 2. The sutures should 
be begun at the apex of the two flaps and comparatively 
deep. 

Disinfect the stump thoroughly and if the hair is sufficient- 
ly long it may be well to draw it down over the wound, to 
which an antiseptic covering has been applied, and retain 
it in position by tying a cord around the hair just be^^ond 
the point of amputation. 

LOfC. 



lOO URETHROTOMY. LITHOTOMY. 

25. URETHROTOMY. LITHOTOMY. 
Fig. 7, 8. 

Objects. For the removal of calculi from the bladder or 
urethra or performing other operations on these parts. 

Instruments. Catheter, convex scalpel, scissors, artery 
and compression forceps, tenacula, lithotome, lithotomy 
forceps, lithotrite, absorbent cotton, drainage tube, suture 
material. 

Technic. Urethrotomy ma}^ be performed on horses in 
a standing position, the hind feet being secured with hobbles. 

It is best, however, to operate under anaesthesia with the 
patient in lateral or dorsal recumbency, either on the operat- 
ing table or cast, being careful to secure as gently as possi- 
ble, having first emptied the bladder if practicable, since 
rupture of an overdistended viscus may readily occur during 
violent struggles by the animal. 

The point of operation will depend upon the location of 
the calculus or other obstacle. If it is found in the pelvic 
portion of the urethra or in the bladder, the operation is 
made at the ischial notch, Fig. 8. First the penis is drawn 
out from the prepuce and the catheter introduced into the 
urethra and pushed upward until it has passed the ischial 
notch. After disinfection of the skin, render it tense and 
make a 5 cm. long incision on the median line at the ischial 
arch through the skin, bulbo-cavernosus muscle, spongy 
portion of the urethra, and the urethral mucous membrane 
down to the catheter. Fig. 8, k. In order to prevent infiltra- 
tion of urine after the operation, special care is to be taken 
to make the lower end of the wound slanting in such a 
manner that the inner margin is higher than the outer. 

After the catheter has been drawn back away from the 
ischial arch, introduce the lithotomy forceps into the urethra 
or bladder, grasp the stone and draw it outward in its natural 
direction. The grasping of the stone by the forceps is 
materially aided by means of the left hand introduced into 



URETHROTOMY. LITHOTOMY. 



lOI 



the rectum. One must avoid grasping, along with the stone, 
the mucous membrane of the bladder. Partial filling of the 
bladder with a tepid aseptic solution will aid in grasping the 
calculus and in avoiding the implication of the bladder walls. 
By careful rotary movement and pushing the forceps back- 
ward and forward the operator can determine before the ex- 
traction of the stone if the forceps can be withdrawn easily 
and without much resistance through the neck of the 




Fig, 7. Urethrotomy at the ischial notch. 

bladder. If the stone is so large that it can not pass the 
neck of the bladder lithotripsy may be performed. This 
operation requires time and patience, since as a rule it is not 
possible to encompass the entire calculus with the forceps. 
That is, the narrowness of the neck of the bladder prevents 
the sufficiently wide opening of the forceps. The stone con- 
sequently must be gradually broken off at its periphery and 
the individual pieces of calculus removed. The character 
of the surface of the stone has an evident bearing upon the 
practicability of lithotripsy. 

When this operation is impossible, the surgical dilation 



I02 



URETHROTOMY. LITHOTOMY. 



of the pelvic urethra with the Hthotome can be undertaken 
as a last resort. Introduce the instrument and divide the 
urethra upward and laterally as the instrument is withdrawn. 
In order to prevent injury to the rectum it should be emptied 
before the operation is undertaken. After the removal of 
the stone, push the catheter again over the ischial arch and 
unite the lips of the wound in the urethral mucous mem- 
brane by means of intestinal sutures. Flush the bladder 




Fig. 8. Urethrotomy (life size). A, skin ; a, retractor penis muscle ; 

b, bulbo- cavernous muscle ; c, spongy urethra ; «, urethra ; k^ 

catheter, 
and urethra by means of a warm, 3 per cent, boric acid solu- 
tion injected through the catheter and then withdraw the 
latter. Finally, suture the skin wound and insert a drainage 
tube or iodoform gauze in the lower angle. The whole wound 
may be left entirely open and dressed daily with antiseptics. 
In case the pelvic urethra has been divided the suturing of 
the external wound is of questionable utility. 

(For student practice on an anaesthetized horse, intro- 
duce a stone into the bladder through the urethral wound 
and practice grasping and removing it with the lithotomy 
forceps. ) 



AMPUTATION OF THE PENIS. 103 

26. AMPUTATION OF THE PENIS. 

Platk XVTT. axd Ftg. 9. 

Instruments. Scalpel, elastic ligature, strong silk 
thread, strong piece of tape i m. long, artery and compres- 
sion forceps. 

Technic. The operation is carried out on the recumbent 
animal under complete anaesthesia, the upper hind foot 
being drawn backward or upward or otherwise so fixed as 
to not obstruct the field of operation. The point of opera- 
tion is determined by the character of the disease and the 
object to be attained. It may be made at any point from 
the glans penis to the attachment of the corpus cavernosum 
to the ischium. If possible amputate in front of the pre- 
putial ring. After the penis is drawn out, and the pre- 
putial region is carefully cleansed with warm water, soap 
and brush and disinfected, an assistant grasps the organ just 
behind the preputial ring and holds it firmly. A temporary 
elastic ligature, T, is then applied above the assistant's 
hand around the penis, or a piece of tape is looped around 
it above the hand and is made to serve both as a tourniquet 
and as a means for holding the penis or it can be grasped 
in front of the ligature with double tenaculum forceps and 
held. Insert a catheter into the urethra and push it beyond 
the elastic ligature or tourniquet. Apply a small cord just 
behind the glans penis, L, Fig. i, Plate XVII, and then 
make a triangular incision on the ventral surface of the 
organ about 4 cm. long by 3 cm. wide, the base of the 
triangle being forward as shown in Fig. i ; carry this 
incision thrbugh the skin, S, the corpus spongiosum, CS, 
and along the corpus cavernosum, CC, down to the urethra, 
U. Disect away the tissues in the triangular area without 
opening or wounding the urethra and when this has been 
completed make a longitudinal incision from near the apex 
of the triangle to its base through the urethral walls to the 
catheter. Beginning at the commissure insert a series of 







.^ (J/) >^ Ih' (0 






^ 2 > -*-■ *-i 










CO O J^ K 3 






w g-Sa s 










tn 


. S S ^ '1 




5 


a o a •" o 




W 


operatio 
let ; CS, 
n; CC, 
I^igature 
ration sh 


> 


PL, 

o 


X 








«.- E3 •»-' <L» 


w 


^ 


ageo 
urniq 
S, Sk 
a; L, 
edop 


< 

i4 


o 


PU 









Fig. I.— First 
ligature used as 
iosum of urethra 
nosum : U, Uret 

Fig.2.— Compl 
U, Urethra. 



AMPUTATION OF THE PENIS. 



107 



interrupted sutures as shown in Fig. II, Plate XVII in such 
a manner that they pass through the urethral wall and the 
skin so that when tied the wounded surfaces are completely 
hidden and the urethral mucous membrane is brought into 
apposition with the integument. Continue these sutures 
down to the base of the triangle after which remove the 




Fig. 9. 

Amputation of the penis, showing needle inserted for a suture. 

V, Dorfeal vessels of penis ; A, Fibrous tunic of the corpus 

cavernosum ; S, Skin ; CC, Corpus cavernosum ; CS, Corpus 

spongiosum of urethra ; U, Urethra. 

catheter and excise the organ by a cut extending in a slightly 
oblique direction from below upwards and forwards. Take 
a straight needle armed with the silk suture and passing 
it through the margin of the utheral wound, the adjacent 
fibrous capsule of the corpus cavernosum and across but 



1 08 VA GINAL O VARIO TO MY IN THE MA RE. 

not through the erectile tissue, insert it again into the 
superior portion of the fibrous capsule and carry it out 
through the adjacent dorsal vessels and the skin as shown 
in Fig. 9, and bringing the ends of the sutures together, 
tie in such a wa}'^ that it brings the uretheral mucous mem- 
brane and the margin of the skin in immediate contact and 
closes the blood vessels securely in such a manner as to 
guard against hemorrhage. By this plan when the sutures 
are tied, the cut borders of the fibrous envelope are brought 
together over the erectile tissue, thus preventing hemor- 
rhage from that tissue also. Insert as many sutures as 
may be required to completely and securely close the wound. 
Finally leave every part wholly covered with epithelium. 
By this plan we hope to avoid stricture of the urethra in 
the process of healing. Remove the tourniquet and release 
the patient. 

27. VAGINAL OVARIOTOMY IN THE MARE. 
Figs. 10, 11 and Pirate XVIII. 

Objects. The alleviation of vice when related to ovarian 
irritation or disease. 

Instruments. .Colin' s scalpel, ratchet ecrasure, 55 cm. 
long. 

Preparation of patient. It is highly important that 
the animal should be kept on a scant laxative diet for at 
least 24 hours and preferably longer prior to the operation, 
so that the alimentary canal shall be somewhat empty and 
thus decrease the tension within that cavity and relieve 
the operator from much annoyance due to the pressure of 
the viscera. 

Technic. The vulvo-vaginal canal of the mare is unique 
in its physiological behavior. Under venereal excitement 
or the introduction of the operator's hand or of tepid water 
the organ has the power of "ballooning" or dilating to a 
degree not seen so far as we know in other animals ; the 



VAGINAL OVARIOTOMY IN THE MARE. 



109 



walls become erected, hard, and stand apart from each 
other, filling the pelvic cavity, the vaginal walls resting 
firmly against the pelvic bones at every part except at the 
points where the bladder and rectum intervene and these 
organs are pressed out flat and occupy a minimum space. 
In the quiescent state the vaginal walls are in contact and 
from the perinaeum forward to within about 10 cm. of the 
uterine os, the vulva and vagina are connected above with 
the rectum by the pelvic connective tissue, while anterior 
to this point the vagina is covered by peritoneum, and it is 
in this area that the incision needs be made in the operation. 
The ballooning of the vagina profoundly alters the relation 
of this operative area, OA, Plate XVIII, and changes it from 
the horizontal in the quiescent organ to the perpendicular 




Special spraying ecraser, 55 cm. long. 





Fig. II. Colin's scalpel, 
in the ballooned condition. These variations permit of 
two methods of operating : I. On the ballooned organ with- 
out anaestnesia and with the animal confined in a standing 
position. II. In the quiescent organ in the recumbent posi- 
tion under anaesthesia : 

I. Without anaesthesia. Secure in the stocks with the 
head elevated, a rope over the back to prevent rearing, 
straps beneath the body to prevent lying down, straps or 
ropes before and behind the animal to prevent backward 



Pirate XVIII. 

Vaginai, Ovariotomy in the Mare. 

Diagrammatic sagittal section through the 
•'ballooned" vagina. V, vagina; O A, opera 
tive area ; I, point of incision ; U, uterus ; R, 
rectum ; A, aorta with dotted lines posteriorly 
to indicate location of the iliacs. 



VA GINAL O VARIO TOM Y IN THE MARE. 1 1 3 

and forward movements, all four feet pinioned to the floor, 
and the tail firmly secured and stretched to a beam above. 
With soap, water and brush cleanse the tail, perineum and 
vulva thoroughly, being especiall}- careful to remove all 
detachable masses of sebum ; 50 per cent, alcohol may be 
used sparingly to aid in removing this. Too free a use of 
alcohol excoriates the delicate skin. Cleanse the clitoris 
carefully. Follow the washing with a free application of 
I : 1000 aqueous sublimate solution to the external parts and 
for a short distance inside the vulvar lips and to the clitoris. 
Do not introduce irritant disinfectants into the healthy 
vagina nor deeply into the vulva as it may cause severe 
straining during and subsequent to the operation and by in- 
juring the vulvo- vaginal mucosa favor subsequent infection 
of the vaginal wound. Wash away the sublimate with a 
tepid .6 per cent, soda bicarbonate solution, and fill the 
vulvo-vaginal canal with the same. After thorough dis- 
infection of the hands and arms remove the disinfectants 
by washing in sterile soda solution, which at the same time 
renders the hand unctuous and readily introduced through 
the vulva. Armed with the guarded sterilized scalpel, Fig. 
II, introduce the right hand into the vagina promptly and 
when it is well " ballooned " unsheath the knife and plac- 
ing it just above the os uteri at I, Plate XVIII, parallel to 
the long axis of the uterus and a few mm. to the right or 
left of the median line, in order to avoid a loose fold of 
mucous membrane generally existing there, the blade be- 
ing held vertiqal, that is the cutting surface parallel to the 
longitudinal muscular fibers of the vagina, and guarding 
the possible extent of its introduction with the thumb and 
fingers, push it directly forward in a straight line with a 
quick thrust through vaginal mucosa, the muscular walls 
and the peritoneum, until the disappearance of resistance 
indicates that the latter has been penetrated. This is the 
most critical step in the operation. 
8 



1 14 VAGINAL OVARIOTOMY IN THE MARE. 

If the hand is introduced immediateh^ after the injection 
of the sterile saline solution the vagina will generally be 
found "ballooned" or will quickly become inflated under 
manual movements. If the solution is thrown out the va- 
gina may collapse and closeh^ invest the hand, in which 
case more of the liquid should be injected when it will again 
dilate. If the hand is introduced without the knife, with- 
drawn and then introduced with it, it will be frequently 
found that the vagina has collapsed and needs a second fill- 
ing with the fluid. Patience until dilation is accomplished 
and promptness to act when attained are prime requisites 
to success. The knife should be pushed through the va- 
gina quickly making a clean wound the width of the blade, 
when the latter is to be withdrawn and laid aside. It should 
be remembered that in this " ballooned " state, the anterior 
wall of the vagina is but 2 or 3 mm. thick and easily pene- 
trated. Introduce the hand again, push one finger into 
the incision, then a second and third, and eventually hold- 
ing all the fingers in the form of a cone push the entire 
hand into the peritoneal cavity. Immediately below the 
incision and continuous with the tissues involved in the 
wound lies the uterus with a transverse diameter of 4 to 6 
cm. With the palm of the hand downwards, trace the uterus, 
U, Plate XVIII, forward a distance of 15 to 18 cm., where it 
ends abruptly in two cornua of about the same size as the 
body, which are given off horizontally at almost right angles. 
Trace these to the right and left for a distance of 14 or 15 
cm., where they end obtusely, and 3 or 4 cm. beyond this 
in a direct line, resting upon the anterior border of the 
broad ligament is the dense oval ovary varying in size from 
2.5 to 7 cm. in diameter. Prepare the ecraseur for use by 
withdrawing the chain until the loop is of barely sufficient 
size to admit of its being readily slipped over the ovary. 
Grasp this loop and the end of the ecraseur tube in the 
hand which is to be used ii^ the operation and carr}- the in- 



VAGINAL OVARIOTOMY IN THE MARE. i r5 

strument to the ovary and drop the loop over it from above. 
Pass some of the fingers beneath the ovary and push it up 
through the chain loop and grasp it there with the thumb 
and index finger. Holding the ovary with one hand tighten 
the chain quickly w4th the other, examine to make sure 
that a loop of intestine is not caught, draw the ovary well 
through and get a large portion of the oviduct, and cut off 
promptl}^ holding to the gland until carried out through 
the vulva. Remove the other ovar^^ in the same way. 
Generall}^ it is most convenient to remove the left ovary 
with the right hand and vice- versa but each may be re- 
moved with either hand. Wash away any blood from the 
external parts, apply sublimate solution freely to the vulva, 
perineum and tail. Keep the patient quiet for five or six 
days, and feed lightl}^ on a laxative diet. 

II. In operating under anaesthesia the animal should 
be cast or confined upon the operating table in lateral re- 
cumbenc}^ preferabl}^ with the posterior part of the bod}- 
somewhat higher than the anterior so as to avoid visceral 
pressure in the pelvic cavit}^ Place the animal under com- 
plete anaesthesia. Prepare the parts in the same manner 
as already described. Carry the knife into the vagina in 
the manner previousl}^ described and render the roof of that 
organ tense by pushing the os uteri downward and forward 
w4th the hand or b}^ means of a vaginal tensor or speculum. 
It is important that the vagina be held well down toward 
the floor of the pelvis so as to carry it away from the rectum 
and posterior ^orta and its branches while the incision is 
being made. The incision is now to be made just above 
and behind and a trifle to one side of the os uteri in essential- 
ly the same manner as under I, except that the cut is now 
made upward and backward instead of directly forward. 
The remainder of the operation is identical with what we 
have described under I. Under anaesthesia the vagina is 
flaccid and can not be made to " balloon." 



ii6 VAGINAL OVARIOTOMY IN THE MARE. 

DANGERS. 

Wounding of the rectum is scarcely possible under the 
first method if care is taken not to attempt the incision until 
the vagina is well "ballooned," and then making the stab 
wound directly forward. If made upwards when the organ 
is so erected the accident is highly probable, and with the 
undilated vagina where it is necessary to cut upwards the 
danger is ever present. Its prevention demands that in: 
I, the operator await the complete "ballooning" and then 
make his incision as directed. In II, the accident is to be 
prevented by being careful to push the vagina down away 
from the rectum and hold it away while the incision is 
being made. If the wound in the rectum passes through 
the pelvic connective tissue behind the peritoneum it is of 
little consequence, but the operation should be abandoned ; 
if the bowel is opened into the peritoneal cavity the accident 
is fatal. 

Wounding of the iliac arteries, which produces prompt 
death from hemorrhage, results from the incision being 
made upwards instead of forwards when the vagina is 
"ballooned " or from a failure to hold the roof of the vagina 
down and away from the part while making the incision in 
the flaccid organ as is the case with the recumbent animal 
under anaesthesia. It is most likely to occur with timid 
operators who become nervous, especially when the vagina 
does not *" balloon " promptly or the mare is not well 
secured. The accident is wholly unnecessary if the operator 
will await the "ballooning" in the first operation while by 
the second method it is prevented by proper care in holding 
the vagina downward and forward during the incision. 
When it has occurred it is generally beyond remedy. 

Wounding of the uterus may occur when the incision is 
directed downward and may greatly embarrass the operator 
and confuse him by passing the hand through the incision 
into the uterine cavity. It is to be avoided in the first 



VAGINAL OVARIOTOMY IN THE MARE. 117 

operation by carefully directing the incision straight for- 
wards ; when the accident occurs it is of little consequence 
beyond the embarrassment and may be overcome bj' again 
dilating the vagina with fresh injections of the soda solution 
and making a new incision, or if preferred the first cut may 
be corrected b}^ placing an index finger against the perito- 
neum at the upper part of the wound, and with a sudden 
and vigorous thrust break through into the peritoneal 
cavity, or the error may be corrected by again using the 
scalpel and directing the incision properly. If it is at- 
tempted to rupture the peritoneum with the finger it must 
be done b}" a sharp thrust since otherwise a large section of 
it will be pushed awa}^ from the subjacent tissues. 

Incomplete penetration of the vaginal wall is liable to 
occur if the scalpel is ^//!// or the vagina imperfectl}^ "bal- 
looned " and flaccid, or if the operator is unduly timid. It 
is best prevented by avoiding the causes as related, and 
once it has occurred it is generall}^ best to again " balloon " 
the organ in the operation without anaesthesia and make a 
new incision either to the right or left of the first. It may 
be overcome also by thrusting the index finger through the 
peritoneum as described in the preceding paragraph or 
completing the cut with the scalpel. 

The mistaking of a ball of feces for the ovary has oc- 
curred to inexperienced operators and the fatal error of re- 
moving the portion of the rectum surrounding the fecal pellet 
committed. The blunder is uncalled for ; the fecal ball is 
movable in tl,ie bowel, the intestine is far more massive 
than the broad ligament, and the ovary is to be definitely 
identified by its being lodged in the broad ligament just 
beyond the end of the cornua, which is continuous with the 
uterus. If, therefore, one traces the uterus forward to the 
coruna, thence along these to their extremities and along 
the border of the broad ligament to the ovar}^, as above 
directed, the error will not occur. 



1 18 VAGINAL OVARIOTOMY IN THE MARE. 

The incision may be made too low and pass beneath 
the broad ligament. It is to be avoided b}^ being careful to 
keep close to the median line and above the os uteri. If it 
occurs the operation may be completed from beneath with- 
out very great difficulty only that the ovary now lies above 
the hand and must be drawn down from on top the broad 
ligament in order to fix the ecraseur upon it 

Infection constitutes always the most serious danger and 
is to be avoided by proper securing of the animal, by the 
avoidance of irritant antiseptics in the vagina, by rigid anti- 
sepsis at every stage, and by carrying out the mechanical 
parts of the operation deliberately, vigorously and neatly. 
If infection should occur it will generally take the form of 
pelvic cellulitis with abscesses and rectal stricture. Enemas 
of a normal salt or soda solution affords the surest relief of 
the stricture and impaction in front of it. The abscesses 
must be watched and opened early into the vagina or rec- 
tum, and the case treated internally and locally according; 
to general surgical principles. 



VAGINAL OVARIOTOMY IN THE COW. i rg 



28. VAGINAL OVARIOTOMY IN THE COW. 

Objects. Increasing the fat or milk-producing qualities 
and the cure of nj-niphomania. 

Instruments. Colin's scalpel, vaginal dilator, Miles' 
spaying shears, spaying ecraseur, 

Technic. Confine the cow in the standing position in 
the stocks, secure the head firmh' and pass two boards be- 
neath the abdomen and sternum to prevent Ij'ingdown, and 
a rope over the middle of the back to prevent arching of 
the spinal column and straining. 

Wash and disinfect the tail and the perineum and flush 
out the vagina with a .5 per cent, solution of carbolic acid 
or lysol at a temperature of about 100° F. Insert the 
vaginal dilator with one hand and push the prolongation at 
the anterior end into the os uteri. With the other hand 
elevate the handle of the dilator and depress and push for- 
ward the uterus, thus rendering the roof of the vagina tense 
and pushing it downward away from the rectum. Carry 
the scalpel into the vagina with the right hand and resting 
it in the oval of the dilator make an incision through the 
roof of the vagina, beginning at a point 8 to 10 cm. posterior 
to the OS uteri and extending backward on the median line 
for a distance of 2 or 3 cm. Be careful to make the incision 
entirely through the mucosa, muscle and peritoneum at the 
first cut, since any failure to complete it tends to cause the 
peritoneum to separate from the muscular coat and form 
a pocket bfetween them, while the serous membrane being 
very elastic renders it difficult to complete the incision. 
Introduce two fingers through the incision, and reaching 
over the side of the vagina to the right or the left, the right 
or left ovary respectively is recognized lying immediately 
against th4 vagina somewhat below it, just at the anterior 
border of the pubis, in a mass consisting of the cord-like 
Fallopian tube and the fimbriae of its pavilion. The ovary 



I 20 VA GINAL O VA RIO TOM Y IN THE CO W. 

may be distinguished as a firm oval mass 2 to 4 cm. in length 
and I to 2 cm. in its lesser diameter attached to the broad 
ligament. If not promptly recognized by the sense of touch, 
trace the vagina and uterus forwards with the fingers from 
the vaginal incision to the cornua and follow^ them as they 
bend forward and downward, and then backward and up- 
ward to the oviducts, until the ovary is reached where it is 
attached to the broad ligament, just beyond the fimbriated 
end. Grasp the ovary between the fingers and draw it 
through the incision into the vagina. Introduce the 
scissors with the other hand, and when the ovary is reached 
open them barely sufficient to admit its attachments between 
the blades and cut it away along with a portion of the 
broad ligament. Or introduce the ecraseur and drawing the 
ovary through the loop of the chain and holding it securely 
until the instrument is tightened, crush it off in this way. 
It is essential that plenty of the broad ligament and oviduct 
be excised with the ovar}^ to insure the entire lemoval of 
the latter, because the accidental leaving of the smallest 
particle of ovarian tissue will cause a development of this 
into abnormally large Graafian follicles, and will tend to 
increase instead of decrease nymphomania. Should the 
animal be pregnant the ovary on the gravid side is dragged 
downward and forward out of reach of the operator's 
fingers, and if it is desired to complete the operation it may 
be necessary to enlarge the vaginal wound and introduce 
the entire hand, when the ovary can be reached and re- 
moved. Generally no after care is necessary. 

The Dangers are similar to those of the mare. The 
iliac arteries may be w^ounded in the same manner as in the 
mare and is preventable by being careful to push the vaginal 
roof well downwards aw^ay from the rectum and sacrum. 
In rare instances fatal hemorrhage follows the cutting off 
of the ovaries wnth the scissors especially in cows which are 
very fat and lack tone as a result of close confinement. For 



O VARIO TOM Y IN THE COW BY THE FLANK. 1 2 1 

this reason it is apparently safer in confined cows to use the 
ecraseur but even this instrument is not wholly proof 
against hemorrhage and fatalities have been rarely recorded 
after its use so that some veterinarians have advised ligation 
of the arteries instead but this is a complex process Avhich re- 
quires much time for its accomplishment. A new danger 
appears in the presence of the rumen, the supero-posterior 
portion of which projects into the pelvic cavity when filled 
with food and if the cut is directed forwards a stab wound 
readily penetrates its walls with fatal results. Make the 
cut upwards and backwards. 



29. OVARIOTOMY IN THE COW BY THE FLANK. 

Instruments. Clipping shears, convex scalpel, spaying 
shears, or ecraseur, heavy needle and thread. 

Uses. Same as the preceding, applicable to heifers or to 
cows in which the vulva is too small to admit the operator's 
hand or in case of diseased vagina or uterus. 

The animal may be secured as in the preceding or con- 
fined in lateral recumbency with the hind legs extended 
backward and the anterior limbs forward. To accomplish 
this loop a rope about the two fore feet, another about the 
two hind feet, and drawing upon these, cast the animal and 
secure it in recumbency with the legs extended and body 
stretched by fastening the ropes to two strong posts about 
8 to 10 m apart. The operation may be performed in either 
flank. 

Clip the hair from the upper part of the flank, disinfect 
an area 15 to 25 cm. square and make an incision about 12 
cm. long beginning at a point equi-distant from the anterior 
tuberosity of the ilium, the ends of the transverse processes 
of the lumbar vertebrae and the last rib and extend it down- 
ward perpendicularly severing the skin and subcutaneous 
muscle. Divide the external oblique muscle in the direction 



122 OVARIOTOMY IN THE BITCH. 

of its fibres by means of the scalpel handle or the fingers 
and repeat the process upon the internal oblique after which 
puncture the peritoneum with the scalpel. Force one 
hand through the opening into the peritoneal cavity and 
search for the ovaries at the same point and by the same 
method as in the preceding operation, that is, locate the 
uterus within the pelvic cavit3^ between the rectum and 
bladder and trace it and then the cornu, and broad ligament 
to the ovary. The uppermost ovary can be drawn out 
through the wound and cut off with the scissors or ecraseur ; 
the lower one must be held with one hand and the instru- 
ment introduced along the arm and when the ovary is 
reached, apply the scissors or ecraseur and cut or crush it 
off. The beginner must always remember that the posi- 
tive means for identifying the ovaries is by tracing the 
uterus from the vagina along its cornua to the Fallopian 
tube and thence to the organ in the broad ligament. 
Cleanse the wound and close the skin incision with con- 
tinuous sutures. 



30. OVARIOTOMY IN THE BITCH BY THE FLANK. 
Pirate XIX. 

Instruments. Spaying knife, suture material. 

Technic. Confine the animal in lateral recumbency, 
preferably upon the right side for a right handed operator, 
the head somewhat depressed, the limbs extended and the 
body well stretched. Clip, shave and disinfect a sufficient 
area in the exposed flank at a point just anterior to and be- 
neath the external angle of the ilium. With one hand grasp 
the skin fold of the flank and render the skin of the region 
tense, while with the other holding the spaying knife like a 
pen make at first a drawing incision from below upward about 
2 to 3 cm. long, ending above at a point slightly below the 
external angle of the ilium, the incision extending through 



OVARIOTOMY IN THE BITCH. 123 

the skin and subcutaneous tissues ; without removing the 
knife from the wound elevate the handle and with a quick 
thrust make a stab wound extending through the external 
and internal oblique muscles and peritoneum at a single cut. 
The operator can determine when the peritoneal cavity has 
been entered by the disappearance of resistance. Introduce 
an index finger into the peritoneal cavity, and as soon as 
this has been entered follow directly along the peritoneum 
upward and backward toward the angle of the ilium where 
the uterine cornua lie covered over by the broad ligament. 
The internal generative organs of the bitch are unique among 
our domesticated animals. The uterus, U, Plate XIX, is 
small and physiologically unimportant, the cornua, RUC 
and LUC, are ample in size and constitute ph^^siologically 
the uterus. The distance from the cornual extremity, LUC, 
to the ovary, O, which is occupied by the Fallopian tube is 
very brief so that the cornua and ovary are well nigh in 
contact. The ovary, O, O, is very small, smooth and com- 
pletely hidden in the pavilion which here constitutes a sac 
having a very small longitudinal opening of 2 to 5 mm. 
The most remarkable feature of the apparatus from a surgi- 
cal standpoint is the great development of the broad ligament 
which is broader than the distance from the lumbar region 
to the abdominal floor, while the uterus and uterine cornua 
are stretched between the vagina, V, and the ovary, O, so 
that they are suspended in the sub-lumbar region resulting 
in a double fold of the broad ligament hanging down like a 
curtain between the parietal peritoneum and the uterus and 
cornua on either side. The broad ligament of the bitch is 
consequently suspended at one point from the sub-lumbar 
region, at the other from the uterus, so that instead of that 
organ being suspended by the ligament the relation is re- 
versed and the ligament is suspended from the uterus, or 
rather uterine cornua. 

In Plate XIX the right broad ligament, BL', is laid out 



Pi. ATE XIX. 

Ovariotomy in thk Bitch. 

Abdomen of a non-pregnant bitch lying on 
the back with the abdominal floor removed and 
the oaientum pushed away. TT, the two pos- 
terior teats ; B, bladder ; V, vagina ; U, uterus ; 
LUC, IvUC, left uterine cornua with a portion 
of its broad ligament, BL, lying across it ; RUC, 
right uterine cornua with its broad ligament, 
BW, turned outwards exposing the full length 
of the cornua. On the left side the ligament is 
divided so that the anterior half rests in its nor- 
mal position while the posterior half, BV, is 
turned back. O, O, ovaries ; R, rectum ; K, left 
kidney; A/V, a line indicating the level of the 
external tuberosities of the ilia. 




p 



■^^~W>k- w 



h 



\ 



^J---^ ^s^-z.---zrMi^ 





-T 



OVA RIO TOM V I AT THE BI TCH. 1 2 7 

Upon the side exposing the right uterine cornu, RUC, while 
on the left side the ligament is divided at about its center 
and the posterior portion, BL', is laid out on the flank, 
while the anterior, BL, is left in its normal position con- 
cealing a portion of the cornu, LUC. Unlike our other 
domesticated animals, the broad ligament is heavily loaded 
with fat which gives it an appearance very similar to the 
omentum, but the net- work is far less conspicuous or want- 
ing, the omentum also extends back into this region so that 
the two are in contact. The ovary being indistinct and 
hidden is difficult to identify directly, and the cornua being 
covered over by the duplicature of the broad ligament is not 
readily reached, so that the finger generally comes in con- 
tact first with the broad ligament of the uppermost cornu 
hanging loose in the peritoneal cavity : engage this between 
the end of the finger and the abdominal wall and draw it out 
through the wound, grasp it and continue drawing upon the 
folds of the ligament, especially upon the median or under- 
most portion until the naked cornu appears through the open- 
ing, seize it and draw out the anterior portion until the ovary 
follows, then grasp the latter with the thumb and index 
finger of one hand and the ovarian ligament with the same 
members of the other and tear the ligament through be- 
tween them by linear tension. Extend the tear through the 
broad ligament as high toward its lumbar attachment as 
is convenient and backward to the neighborhood of the uter- 
ine bifurcation. Draw upon the exposed cornu until the bi- 
furcation appears, when the other branch is to be grasped 
and drawn out through the opening. In young puppies the 
securing of the second cornua is very difficult and requires 
great care to prevent its rupture. The object may be facili- 
tated by pressing the upper flank of the bitch downward, 
thereby greatly diminishing the transverse diameter of the 
abdomen. 

The succeeding operation (31) avoids this difficulty in a 



128 OVA RIO TOM V FN THE BITCH. 

large measure. Should the distal cornu be ruptured and 
with its ovary drop away from the operator, it becomes nec- 
essar}^ to turn the animal over and make a second incision 
on the opposite side, somewhat further forward. When the 
second cornua has been secured draw it out as far as practica- 
ble and holding it tense insert an index finger along it until 
the ovary is reached, which is recognized by its slightly 
greater size and density succeeding the brief neck represent- 
ing the Fallopian tube between the end of the cornu and 
ovary, while beyond it can be felt the ovarian ligament. 
Engage the ligament between the end of the index finger 
and the abdominal wall, and with a firm and vigorous move- 
ment, using the finger end and nail as a curette, rupture 
the ovarian ligament by drawing the finger toward the in- 
cision, and with the aid of tension upon the cornu draw the 
ovary out through the abdominal incision and divide the 
broad ligament as before. Remove the cornua with the 
attached ovaries by rupturing them transversel}^ near the 
bifurcation by means of linear tension. 

If the bitch be pregnant and especially if far advanced the 
uterine coronua will lie upon the abdominal floor, much en- 
larged and very much more flaccid than the nongravid uterus 
and feeling very much like intestines. The change in the 
position of the uterus has caused the unfolding of the dupli- 
cature of the broad ligament so that it no longer covers the 
cornu. In such cases the operation is performed in the same 
way except that rupturing the blood vessels by linear ten- 
sion does not insure against hemorrhage and it is necessary 
to ligate the ovarian and uterine arteries with catgut or silk. 
In cases of pregnancy the entire cornua should be drawn 
out and a strong ligature placed around the uterus or vagina; 
and the ovaries, uterine cornua and their contents be re- 
moved €71 masse. Release the upper posterior limb and close 
the cutaneous wound by a continuous suture. 

Dangers, Rupture of the uterine cornu alluded to above. 



OVARIOTOMY IN THE BITCH. 129 

It is always to be remembered that the leaving of one ovary 
in position even though the other gland with the two cornua 
and uterus are removed, induces intense oestrum and 
renders the animal if anything more disagreeable than be- 
fore the operation. 

The ureter may be mistaken for the cornu but is smaller, 
is closel}^ attached to the abdominal walls, and does not 
have the broad ligament with its large deposit of fat. The 
kidney is far larger than the ovary, more exposed, and 
located more anteriorly. 

The iliac arteries are at times caught and ruptured by the 
finger but the blunder is uncalled for except through 
nervousness of the operator. 

Instances of puncturing the bladder in making the in- 
cision have been reported. If the bitch has been led out 
and caused to urinate prior to operating, the accident is 
made practically impossible. 



31. OVARIOTOMY IN THE BITCH BY THE LINEA ALBA. 
Pirate XIX. 

Instruments. Same as in the preceding. 

Technic. Confine in the dorsal position with the head 
sharpl}^ declined. Shave and disinfect an area on the median 
line about 6 cm. square extending forward from the pubic 
brim. Make an incision on the median line about 4 cm. 
long beginning just in front of the pubic brim and extend- 
ing forward cutting entirely through the skin, the linea 
alba and peritoneum. Insert an index finger and identify 
the uterus or broad ligament by its location and form. The 
finger usually comes in contact first with the urinary 
bladder which may more or less obstruct the passage to the 
uterus according to its degree of distension. When empty 
as shown at B, it offers practically no obstruction. When 
9 



I30 OVARIOTOMY IN THE BITCH. 

very much distended it may be evacuated b}- gentle pressure 
with the fingers. The operator should be careful not to 
draw the bladder out through the incision as its replace- 
ment ma}^ prove difficult and its puncture with the hypo- 
dermic needle or an enlargement of the abdominal incision 
may be necessary in order to bring about its return. Push 
the bladder aside if necessary and just above it and below the 
rectum the uterus should be readily distinguished and either 
it or the broad ligament caught by the finger and brought out 
through the incision after which the operation preceeds in 
the same manner as by the flank method. B}^ passing an 
index finger forward to reach the lower surface of the rec- 
tum in front of the uterus and then drawing it backwards 
the finger passes between the former and the cornua and 
the latter is picked up. It has a distinct advantage over 
the flank method in that in puppies there is not so much 
difficulty in bringing out the ovaries, nor the danger of the 
rupture of the cornua and the ovary being retained. By 
the use of retractors in the abdominal incision the operator 
is enabled to see the uterus in position and grasp it by 
means of forceps, obviating the necessit}^ for introducing 
the finger into the peritoneal cavit3^ The sutures must 
extend entirely through the abdominal wall and be carefully 
placed in order to prev^ent hernia. Interrupted sutures are 
preferable. If the operation has been properly performed 
no bandage is necessary and the patient will not disturb the 
sutures. If asepsis has not been strictly followed infec- 
tion may occur and the consequent irritation cause the 
patient to tear the sutures out, wdiich may lead to protrusion 
of the intestines or other abdominal viscera. If the sutures 
do not include the deeper layers of the abdominal wall 
hernia is liable to occur and require a second operation. 



\ 



OVARIOTOMY IN THE CAT, 131 

32. OVARIOTOMY IN THE CAT. 

Instruments. Same as for the bitch. 

Technic. The cat ma}^ be spa3'ed b}^ either the flank 
method or through the linea alba. The point of incision in 
either case is the same as in the bitch but owing to the 
smaller size of the animal it is necessary to make the wound 
quite small. The abundance of fur renders it essential that 
an ample area be shaved and the surrounding hair be 
saturated with a disinfectant and carefull}^ brushed away 
from the operative area. The cat being more subject to 
infection than the bitch the aseptic precautions must be of 
the strictest possible character. The operative area must 
be thoroughh^ disinfected and cleansed and equal care must 
be taken not to introduce irritant disinfectants into the 
wound. A great danger also exists in the tendenc}' of the 
abdominal muscle layers to readily become separated by 
pressure from the finger and form a pocket in which wound 
discharges accumulate and constitute a dangerous seat for 
infection. Great care must therefore be taken to make a 
clean incision directly into the peritoneal cavity and to 
avoid separating the peritoneum from the muscles or the 
muscular layers from each other. The uterus and ovaries 
of the cat are naked and far more easily distinguished than 
in the bitch, there being no extra deposit of fat in the broad 
ligament. The sutures are to be applied to the wound in 
the same mann<er as in the bitch. 



1 32 C ASTRA TION OF CR YPTORCHID HORSES. 

33. CASTRATION OF CRYPTO RCHID HORSES. 
Pirates XX and XXI. 

Instruments. Scalpel, emasculator. 

Technic. Confine the animal by casting in the dorsal 
position with the hocks well flexed and both posterior 
limbs completely abducted so as to fully expose the inguinal 
region. Or secure upon the operating table on the side 
opposite to the retained gland and abduct the upper posteri- 
or limb by drawing it upward by means of a pulley. Cleanse 
and disinfect the inguinal region. Anaesthetize. Make 
an incision about 10 to 12 cm. long through the skin and 
subcutaneous tissue directly over the normal position of the 
scrotum, parallel to the median raphe about 4 or 5 cm. 
distant from it. Insert the two index fingers in the wound 
and press them into the areoler tissue toward the external 
inguinal ring and then drawing them apart separate the 
tissues sufficiently to permit the entrance of the hand. 
With the fingers held in the shape of a cone bore a passage 
in the areolar tissue through the external abdominal ring 
and continue in a direction approximately toward the ex- 
ternal angle of the ilium. Unless rectal exploration shows 
that the testicle is within the abdomen, take care in travers- 
ing the inguinal space between the external and internal 
rings that the gland is not passed by unrecognized (inguinal 
cryptorchidy) lying in this region covered by peritoneum 
and the cremasteric fascia. Search in the muscular wall 
for the internal inguinal ring which varies greatly in 
different individuals but usually reveals itself to the fingers 
as an oblong slit or ring covered only by peritoneum. 
Through this may extend a portion of the gubernaculum 
testis or of the vas deferens or epidid3mius which latter may 
have descended into the scrotum while the testicle remains 
in the abdomen. 



C ASTRA TION OF CR YPTORCHID HORSES. 1 33 

Examining Plate XX, the peritoneal view of the internal 
ring is shown crossed by the dotted line, V, of the upper or 
right testicle, into which extends a short distance the tail 
of the epididymus. In the lower or left testicle the ring 
has been opened and the gland lies in a position correspond- 
ing to the right and showing the epididjanusand vas defer- 
ens lying in the processus vaginalis, P. The surgical rela- 
tion of the parts is further illustrated in Plate XXI, where 
the testicle is completely withdrawn into the peritoneal cavity 
and spread out over the right flank. The processus 
vaginalis, P, is outlined by a dotted line into which is in- 
troduced a curved sound, S, along side which lies the 
gubernaculum, G. The gubernaculum, it will be observed 
is divisible into three sections, a slender one, G, which by 
passing along behind the peritoneum escapes from the 
abdominal cavity at the postero-external commissure of the 
ring to extend to the scrotum. The second portion of this 
organ, G', is much thicker and extends from G to the 
epididjmius at E, while the third division, G", extends from 
the epididymus to the testicle. 

In Plate XXI it is shown that the testicle under all ordinary 
conditions is inevitabl}^ attached through its gubernaculum 
testis to the posterio-external commissure of the ring and 
that it has a second definite attachment to the seminal 
bladder through the medium of the vas deferens, V, and a 
third by means of the testicular arter}^, A. The guber- 
naculum and the vas-deferens constitute the essential guides 
in locating arjd recognizing the testicle. 

By forming a hollow cone with the fingers about the in- 
ternal ring, the vas deferens, epididymus and gubernaculum 
tend to drop out into the processus vaginalis where they 
may be grasped with the fingers without the peritoneum 
having been ruptured. The vas deferens and epididymus 
present characteristics which are unmistakable to the 
trained touch consisting of a small firm cord (vas deferens) 



PI.ATE XX. 

Castration of Cryptorchid Horse. 

Urino genital apparatus of 24 hr. colt. T, T, 
testicle ; A, testicular artery ; G, gubernaculum 
testis ; V, V, vas deferens ; B, uricary bladder ; 
UA, umbilical arteries retracted within abdomen; 
P, processus vaginalis ; UV, umbilical vein. 



CAS TRA TION OF CR YPTORCHID HORSES. 1 37 

or a small mass of fine threads (tail of epididymus) which 
roll freely between the thumb and finger and give a sensa- 
tion which is unlike that produced by any other tissue in 
the body. Grasp the part firmly and tearing through the 
peritoneum seize the vas deferens and carefully draw it out 
through the external wound. (In teaching cryptorchid 
castration to the beginner we make our opening down to 
the internal ring and grasp the vas deferens between the 
thumb and finger without penetrating the peritioneal cavity 
and then passing a pair of long uterine dressing forceps 
along the hand, fasten them upon the vas deferens. The 
student then completes the operation, using the forceps as 
a guide. He thus learns the direction and character of the 
parts and recognizes the internal ring with the peritoneum 
still stretched across it, intact.) 

In case the vas deferens can not be felt before rupturing 
the peritoneum, it may be broken through with the index 
finger and inserting this into the cavity the gubernaculum 
is found attached to the postero-external border of the ring, 
and but a short distance therefrom the finger comes in con- 
tact with the vas deferens or with the tail of the epididymus 
where the gubernaculum crosses it at E, in Plate XXI. Hav- 
ing reached the vas deferens the operation is proceeded with 
as above. Thus far the operator has not concerned himself 
with the location of the testicle but relies wholly upon the 
vas deferens or gubernaculum, since when either of these 
are recognized the testicle is virtually within his power. 
He thus proceeds upon the basis that he is not to Jj7id the 
testicle for the reason that it is not lost but that it has de- 
finite relations and attachments which permit of certain 
displacements of the organ itself but not of its attachments. 
Having drawn the vas deferens out through the wound 
tension is exerted upon it which tends to cause the testicle 
to follow but sometimes the gland is too large to pass the 
internal ring and the latter needs to be dilated some by 



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CASTRATION OF CRYPTORCHID HORSES. 141 

means of inserting an index finger in it or the testicle 
needs to be guided through the opening. 

We have described herein one method of castrating a 
cryptorchid horse where the cryptorchidy is due to an arrest 
in the development of the gland and of its descent. There 
are other methods employed which introduce variations at 
at each step, many operators making the incision over the 
external ring instead of near the median line and it is even 
more common for the operator to avoid opening the internal 
ring and penetrating the peritoneal cavity somewhat in front 
of and above it through the small obhque muscles. When 
one plan has been learned the variations are easil}^ applied. 
There are other causes of cryptorchidy in rare cases which 
require a different procedure in order to extract the gland 
which varies with particular cases but the essentials for the 
discovery and recognition of the testicle are the same. 

Prior to attempting the operation it is well to make a 
rectal exploration and determine as far as may be the loca- 
tion of the testicle, whether it be on the right or left side, 
and its character, should it be in any way pathologic. After 
the testicle is brought to the surface it may be removed 
with the emasculator or by such means as the operator may 
prefer. Cryptorchid testicles when due to arrest in develop- 
ment are not vascular and there is little tendency to hemor- 
rhage after excision. Place an antiseptic tampon in the 
wound, pushing it well up against the internal ring and re- 
tain it in position b}^ means of sutures for a period of 24 to 
48 hours when it is removed and the wound dressed anti- 
sept i call y. 

The operation for cryptorchidy in the smaller animals is 
essentially the same as in the horse except that the incision 
is to be made ordinarily through the flank as in spaying. 
The same attachments are to be our guide and the operation 
is to proceed upon almost parallel lines. 



IV. OPERATIONS ON THE EXTREMITIES. 

34. TENOTOMY OF THE FLEXOR PEDIS TENDONS. 
Pirate XXII. 

Objects. The relief of contraction of the flexor tendons 
of the foot. 

Instruments. Razor, scissors, sharp tenotome, bandage 
material. 

Technic. Tenotomy is generall}^ performed on the deep, 
or flexor pedis tendon, seldom on the superficial, or flexor 
of the OS coronae. 

Confine upon the operating table with the affected 
member undermost and the foot fully extended. In default 
of a table confine in lateral recumbency and apply an exten- 
sion spHnt to the foot as shown in Plate XXII. 

On the median side at the middle of the metacarpus or 
metatarsus the skin is shaved and disinfected over the 
tendon of the flexor pedis muscle. The location named lies 
between the lower extremity of the great carpal or tarsal 
sheath above and the superior extremity of the tendonous 
sheath of the fetlock below, so that neither of these is 
wounded during the operation, but the tendon is severed at 
a point where it is invested by loose connective tissue which 
retains the divided ends in their normal Hne of direction, 
somewhat fixed, and favors their ultimate reunion. 

Grasp the metacarpus or metatarsus in this area from 
above and behind in such a manner that the thumb rests 
upon the median or upper surface, and the index and second 
fingers on the lateral or under side of the flexor pedis 
tendon. While the left thumb pushes the skin toward the 
bone, that is, forward, a sharp pointed tenotome held per- 
pendicularly in the right hand is introduced with the cutting 
edge toward the hoof through the skin, subcutem and anti- 
brachial fascia down to the flexor pedis tendon. Immedi- 
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144 PERONEAL TENOTOMY. 

ately on the anterior bordor of the tendon insert the teno- 
tome so far that the point of it can be felt on the lateral or 
outer side through the skin with the left hand. The cut- 
ting edge of the knife is then turned against the tendon of 
the flexor pedis, that is, it is directed backward, the foot is 
extended by an assistant with the aid of a rope bound 
around the pastern and looped over the hoof, and the ex- 
tensor pedis tendon is cut through under light pressure, the 
operator pressing the handle of the knife downward and 
forward, using the metacarpus or suspensory ligament as a 
fulcrum upon which the back of the tenotome rests as a 
lever. A loud cracking, as well as the disappearance of 
resistance to extension shows that the tendon has been 
severed. By keeping as close to the anterior border of the 
tendon as possible we can avoid injury to the plantar nerve, 
the common digital artery, the internal cutaneous, and the 
internal and external interosseous veins which run between 
the flexor pedis and the suspensory ligament. 

After the removal of the knife and seeing that there is a 
wide space between the ends of the tendon, the foot is un- 
bound from the splint and a bandage applied to the meta- 
carpus, which rests upon the fetlock joint and remains in 
position for eight days. Healing of the cutaneous wound 
by primary union. 



35. PERONEAL TENOTOMY. 
PI.ATK XXIII. 

Object. The relief of Stringhalt. 

Instruments. Razor, scissors, sharp tenotome. 

Technic. On the lateral side of the metatarsus a triangle, 
d, opening toward the tarsus is formed by the tendons of the 
extensor pedis longus muscle, /, and the lateral extensor of 
the foot, e, which unite on the anterior surface of the middle 
of the metatarsus. The synovial sheath of the extensor 




Pirate XXIII. 

Peroneai, Tenotomy for Stringhai^t. 

Right hind foot seen from the external side. 
The skin covering the lateral extensor of the 
foot is laid back in the form of a flap, the crural 
fascia divided. e. Peroneal tendon ; /, crural 
fascia ; /, tendon of the anterior extensor pedis 
musale ; d, the triangle formed by / and <?. 



lO 



145 



146 CUNEAN TENOTOMY. 

pedis longus muscle extends inferiorly to near the point of 
juncture of the two tendons ; the sheath of the lateral ex- 
tensor ends below 3 to 4 cm. above the point of union. In 
the middle of this space without a sheath, which is 3 to 4 
cm. long, and below the annular ligament of the hock the 
operation is carried out. After the skin hos been shaved 
and disinfected, confine in the stocks or operate upon the 
standing horse, with the aid of locil anaesthesia, a twitch 
being applied to the nose and the opposite hind foot held up 
with the side-line. The tendon of the lateral extensor is 
easily felt under the skin as a hard cord about .7 to i 
cm. in diameter. Stretch the vSkin and with the back of 
the hand toward the hock grasp the tendon with the thumb 
and index finger of one hand, insert the tenotome with the 
cutting edge toward the foot perpendicularh' upon the tendon 
through the skin, subcutem and aponeurosis derived from the 
crural fascia ; push it from before backward under the tendon, 
turn the cutting edge against it, and with the hock extended 
sever the tendon as well as the fascia through to the skin. 
In accomplishing the section of the tendon the knife is to be 
used as a lever of the first class with the anterior border of the 
metatarsus acting as a fulcrum. If the tendon has been 
complete!}^ severed its retracted ends ma}^ be felt under the 
skin I to 2 cm. above and below the wound. After the op- 
eration an antiseptic bandage is applied, resting upon the 
fetlock. The bandage should remain eight da3^s and the 
cutaneous wound heal by first intention. Care should be 
taken to not wound the tendon of the extenson pedis longus 
muscle. 

36. CUNEAN TENOTOMY. 
Pirate XXIV. 

Objects. The relief of spavin lameness. 
Instruments. Razor, scissors, straight scalpel, Peters' 
spavin knife. 

Technic. Most horses can be operated on standing, with 




PI.ATK XXIV. 
, CUNEAN TlINOTOMY. 

For the relief of spavin lameness. CT, 
cunean tendon. The dotted line crosses the 
ergot. 



148 NEUROTOMY. 

the aid of cocaine, otherwise cast, or secure on the operating 
table, on the affected side and extend the tarsus. Shave 
and disinfect an area 5 to 6 cm. square on the inferior median 
surface of the hock over the course of the cunean tendon of 
the chief flexor of the metatarsus, as indicated in Plate 
XXIV. Locate the tendon, CT, by palpation as it passes 
obliquel}^ downward and backward and make a transverse 
incision about i cm. below its inferior border at a point 
midway between the anterior and posterior borders of the 
hock, or slightly anterior thereto, the width of the scalpel 
blade. Push the tenotome flatwise between the skin and 
tendon, as shown in the plate, force it upwards to the 
superior border of the tendon, then turn the cutting edge 
toward it and elevating the handle, using the superior border 
of the wound as a fulcrum, cut the tendon through from 
w^ithout inwards. By firm pressure upon the tenotome in 
the latter method periosteotomy is simultaneously accom- 
plished. The completion of the operation is evidenced by 
the separation of the cut ends of the tendon leaving a well- 
marked depression at the point of division. Disinfect the 
wound, apply an antiseptic bandage resting upon the fetlock 
and allow to remain undisturbed for six days. Healing by 
primary union. After the incision through the skin has 
been made, the Peters' knife may be UvSed instead of the 
straight scalpel, and the tendon and periosteum cut through 
at two or three different points, the cuts diverging upwards 
from the cutaneous wound, V-shaped. 



NEQROTOMY. 

General Remarks. Neurotomy is performed for a vari- 
ety of objects, such as the relief of pain in a sensitive nerve 
itself, as in trifacial neurotomy, 10, pp. 55-6, the relief of 
pain or lameness in a part supplied by a sensory nerve, or 
the inhibition of motor power, as in the "cribbing" opera- 
tion. ^ 



NEUROTOMY. 149 

The following neurotomies are designed to relieve pain 
and the consequent lameness dependent upon a pathologic 
condition of some part or tissue on the distal side of the 
point of operation and to which the divided sensory nerve 
is destined. 

Neurotomy of a sensory nerve is always a painful opera- 
tion, and its performance without anaesthesia is unjustifiable 
from a humane standpoint, and cannot be so well done either 
from the view of mechanical correctness or the carr3dng out 
of antiseptic standards. Some neurotomies can be well per- 
formed on the standing animal if it is quiet and the operator 
is experienced, the parts being rendered insensitive by 
means of cocaine or other local anaesthetic ; in the greater 
neurotomies general anaesthesia may be desirable or necessa- 
ry from the humane or operative standpoint. 

The confinement of animals for neurotomy on the sensory 
nerves of the extremities for the relief of lameness is always 
to be viewed as a critical procedure for the reason that the 
operation is generall}' made because of the local manifesta- 
tion of a more or less general disease which is accompanied 
by fragility of the skeleton, and as a result most casting acci- 
dents occur in cases of confining for neurotomy or firing in 
cases of lameness belonging to the great group of dry 
arthritis or spavin family. Casting must, therefore, be done 
with the greatest possible care, and the operating table is to 
be constantly and greath^ preferred. 

Neurotomy is properly a last resort in lameness and should 
not otherwise be performed. It has two great and ever 
present dangers. If the part deprived of sensation is too 
badly diseased to bear the weight and resist the insult result- 
ant upon the part being called to do its normal or even an 
extra amount of work, it must ultimately give way, the 
bones become fractured, the tendons separate from the bone, 
the intra-ungular tissues lose their integrity and the hoofs 
become detached (exungulation) or other degenerative 



I50 NEUROTOMY. 

changes take place as a result of causing a part to do a work 
for which its condition unfits it. 

The second great danger occurs from wounds or other 
traumatisms to the tissues distal to the operation when the 
unnerved parts are not rested as the}^ would be in natural 
conditions when injured, and as a result reparative changes 
are prevented and supplanted by retrograde processes with 
ultimate death of the part and of the animal. 

Nerves are generally accompanied by satellite arteries and 
veins which are always liable to be wounded during the 
operation and are more embarassing because of the hemor- 
rhage clouding the operation field and inviting error than 
dangerous because of the loss of the blood itself. It is essen- 
tial to a good operation that the hemorrhage be kept under 
control throughout so that each tissue will stand out in good 
relief and the nerve reveal its identity in addition to its loca- 
tion, size and relations, by its intensely white, nacrous, 
striated character. The test of compressing the nerve in 
order to identify it by the resultant pain is unsurgical and 
unnecessarily cruel. 

Sepsis holds an important place in considering the dangers 
of neurotomy because the infection of a sensitive nerve 
causes very great pain and if considerable, tends to cause a 
false neuroma or fibroma in the connective tissue of the 
nerve trunk, calling for a second operation in order to re- 
move the tumor, and resultant lameness. 

Neurotomies should consequently be performed onl}^ in 
properly selected cases, the smallest possible trunk that will 
sufficiently relieve the pain should be selected for the opera- 
tion, it should be performed with due regard for suffering 
and for asepsis, should be performed quickl}^ and neatly, the 
incisions being free, laying the nerve trunk bare without 
tearing up the tissues and clouding them and at every point 
aim at celerity, accuracy and neatness. 



DIGITAL NEUROTOMY. 151 

37. DIGITAL NEUROTOMY. 
Plate XXV. 

Objects. The relief of navicular lameness in cases where 
plantar neurotomy is not deemed necessary or advisable. 

Instruments. Razor, scissors, scalpel, probe pointed 
bistour}^, tenacula, aneurism needles, bandages. 

Technic. Digital neurotomy may generally be perform- 
ed on the standing animal, the operative area having first 
been anaesthetized by means of cocaine or otherwise, a 
twitch applied to the upper lip and the affected foot held up 
by the assistant. If necessary because of restlessness of the 
animal or inexperience of the operator, confine on the oper- 
ating table or cast the animal and apply the extension splint 
to the foot to be operated on as shown in Plate XXII, except 
that the lower binding cords rest on the metacarpus instead 
of the pastern. Extending downwards from the fetlock 
joint toward the coronet, between the posterior border of 
the phalanges and deep flexor tendon there is a slight furrow, 
at the posterior part of which, close to the external margin 
of the tendon, lies the median or principal digital nerve ac- 
companied in front by the digital artery, A, anterior to 
which lies the digital vein, V. Immediatel}^ behind the 
nerve and generally lying a trifle deeper, is quite commonly 
found a second venous trunk of considerable size. Near the 
middle of the first phalanx the nerve is crossed externally 
in an oblique direction from above to below and from behind 
to before by a white ligamentous band, L, slightly broader 
than the nerve extending from the base of the ergot of the 
fetlock to the retrossal process of the pedal bone. This must 
not be mistaken for the nerve, N, and need not be if it is re- 
membered that the latter is accompanied on the same plane 
and in a like direction by the satellite artery. A, and vein, V, 
enclosed with it in a fibrous sheath. At the uppermost part 
of the first phalanx the nerve lies in front of this ligament, 



PI.ATE XXV. 
DIGITAI. NEUROTOMY. 

V, Digital vein ; A, digital artery ; N, digital 
nerve ; L, ligament. 



\ 



DIGITAL NEUROTOMY. 



155 



a short distance inferiorly it passes beneath it, while from 
the middle of the pastern downwards the nerve lies behind 
the ligament. 

The operation is practicable at any point over the line of 
the nerve from the top to the bottom of the shaved area in 
Plate XXV or from the superior end of the first phalanx 
down to a level with the superior border of the lateral carti- 
lage, but perhaps preferably at about the middle of the 
pastern. At the desired point and over the groove between 
the flexor pedis tendon and the phalanges shave and disin- 
fect an area 4 to 5 cm. square. In the center of this area 
at the anterior border of the flexor tendon, with the scalpel 
held perpendicular to the skin, make an incision from above 
downwards a distance of from 2 to 3 cm. cutting cleanly 
through the skin and subcutaneous fascia down upon the 
nerve. The incision is favored by tensing the skin between 
the thumb and index finger of the left hand, but care should 
be taken not to displace it backwards or forwards. Dilate 
the wound by pressure with the thumb and index finger or 
otherwise and carefully incise longitudinally the fibrous 
sheath enveloping the nerve and artery. Pass an aneurism 
needle beneath the nerve, and follow with a second one 
immediately beside the first. Draw the two apart, one 
toward the toe, the other toward the fetlock, and separate 
thereby the nerve from the surrounding tissues. Remove 
one aneurism needle, insert a probe pointed bistoury, or scis- 
sors beneath the nerve, and divide it at the upper angle of 
the wound and excise a section 3 cm. long. Disinfect and 
bandage with or without suturing the w^ounds. I^eave the 
bandage in place 6 to 8 days. 



Plate XXVI. 

Pr^ANTAR Neurotomy. 

a, lateral digital artery ; v, lateral digital vein; 
«, common lateral digital nerve ; d, anterior 
branch ; o^ posterior branch ; 5, superficial flexor 
tendon ; p, perforans tendon ; ?, suspensory 
ligament of fetlock ; w, metacarpus. 



\ 



PLANTAR NEUROTOMY. 159 



38. PLANTAR NEUROTOMY. 
PI.ATE XXVI. 

Objects. The relief of navicular, or ringbone lameness 
or other painful, non-suppurating disease of any parts below 
the fetlock joint. 

Instruments. Razor, scissors, convex scalpel, compres- 
sion artery forceps, tenacula, aneurism needles, suture ma- 
terial, elastic ligature. 

Technic. It is well to apply a bandage saturated with 
sublimate or creolin solution to the fetlock joint 24 hrs. be- 
fore the operation in order to secure thorough disinfection. 

Confine the animal and fix the limb as in the preceding 
operation. After the removal of the disinfecting bandage, 
shave the site of operation and thoroughly disinfect the 
region of the metacarpus and fetlock with soap, brush, and 
sublimate or creolin solution and 50% alcohol. Passing 
the fingers from before to behind with light pressure over 
the region just above the fetlock joint, there is felt immedi- 
ately in front of the flexor pedis tendon a channel-like de- 
pression extending from above the fetlock downward over 
it. Just at the anterior margin of the flexor pedis tendon 
and at the posterior part of the groove lies the threadlike 
cord of the nerve, n, 3 mm. thick, which glides away from 
underneath the fingers with a distinct recoil. The site of 
operation lies immediately above the fetlock in the posterior 
third of the metacarpus or one may operate at any point 
higher up as far as beyond the middle of the metacarpus or 
metatarsus so long as care is taken to include the anasto- 
mosing branch given off by the median plantar nerve at 
about the middle of the metacarpus and bending obliquely 
around behind the tendons to join the lateral nerve some- 
what lowef down. At this point stretch the skin between 
the thumb and index finger of one hand and make an incision 



1 60 NE UR O TOM Y OF THE MEDIA N NER VE. 

3 to 5 cm. long, the lower angle of which is just above the 
fetlock joint, cutting directl}^ through the skin, subcutem 
and connective tissue sheath down onto the nerve, laying 
it bare. The borders of the cutaneous wound are held apart 
with tenacula and by palpation with the fingers or by vision 
it is determined if the nerve lies in the middle of the wound. 
If necessary continue the dissection with the scalpel until 
the nerve is clearly revealed ; it is distinguished by its faint- 
ly yellowish color, its fine longitudinal striae and its location 
behind the metacarpal artery. Immediately above the fet- 
lock joint the median metacarpal or metatarsal nerve divides 
into an anterior smaller, d, and posterior larger branch, 0. 
This division should be laid bare in order that the operator 
may not erroneously cut one branch only. Immediately 
above this point of division the aneurism needle is passed 
under the nerve, then a second instrument is inserted beside it 
and the two pulled apart separating the nerve from the ad- 
jacent tissues, the scissors or a small probe-pointed bistoury 
is passed beneath and it is cut through quickly at the superior 
angle of the wound. The distal end of the nerve is then 
dissected free downward and both branches excised at the 
lower angle of the wound so that a section 3 to 5 cm. long 
is removed. The cutaneous wound is united by a continuous 
suture and a temporary bandage applied. If the horse has 
been secured by casting, the extension splint, if it has been 
used, is then removed, the foot replaced in the hobble and 
the horse turned to the other side. The operation on the 
opposite metacarpal nerve is carried out in the same way 
after which a sterile bandage is applied and allowed to re- 
main eight daj^s. Healing by primary union. 



39. NEUROTOMY OF THE MEDIAN NERVE. 
PI.ATE XXVII. 

Objects. The relief of lameness due to disease so located 
in the anterior limb that it cannot be overcome by plantar 
neurotomy. 



NE UR O TO MY OF THE MEDIAN NER VE. 1 6 1 

Instruments. Razor, scissors, convex scalpel, artery 
and compression forceps, tenacula, aneurism needles, suture 
material. 

Technic. The operation is performed on the median 
surface of the anterior limb immediately below the humero- 
radial articulation on the recumbent horse after the affected 
foot has been fully extended on the operating table or in de- 
fault of this removed from the hobbles and bound upon the 
extension splint as shown in Plate XXII. Anaesthetize. 
The foot is drawn out firmly from the shoulder, inclined 
somewhat forward. The operator places himself between 
the neck and the forearm and, after the median region of 
the elbow joint has been washed with soap and water, 
searches for the median nerve where it glides over the pos- 
terior part of the joint to disappear behind the radius. 
Shave the skin at and below this point, disinfect it with 
sublimate or creolin solution and 50% aclohol. The 
nerve, ?^, lies as a rule somewhat in front of the middle of the 
median side of the forearm against the postero-internal 
margin of the radius and can be felt, about 5 to 6 mm. in 
diameter, lying somewhat deeply. The position of the nerve 
varies with the different attitudes of the forearm. In fat 
and fleshy horses the identification of the nerve is more 
difficult. It may be felt upon the standing animal. 

With the nerve lying between the thumb and index finger 
of the left hand, at the point where it begins to disappear 
behind the radius after having passed over the humero- radial 
articulation, stretch the superposed skin and immediately 
upon and parallel to it make an incision 5 cm. long, finst 
through the skin, then through the sterno-aponeuroticus 
muscle. Any hemorrhage from the skin, subcutis, or mus- 
cle, is checked. The tenacula are inserted cautiously in the 
lips of the wound, and these being drawn apart the white 
anti-brachial fascia is brought into view and a search is 
made with the index finger to determine the exact location 
II 



PI.ATE XXVII. 
Median Neurectomy. 

Median surface of the right humero. radial 
articulation, a, brachial artery ; n, median 
nerve ; z/, brachial vein ; /, antibrachial fascia ; 
p^ sterno-aponeuroticus muscle. 



\ 

% 



•r-s i:st^-^~i>-'S&^^i^ 




NEUROTOMY OF THE MEDIAN NERVE. 165 

of the nerve, and the fascia is divided with the scalpel and 
an oval piece excised with the scissors immediately over it. 
If much fatty tissue is found beneath the fascia it may be 
dissected away carefully with the scalpel or cut away with 
the scissors. There now comes into view a delicate reddish 
colored fascia-like membrane, the nerve sheath, behind 
which a blue cord, the brachial vein, V, is visible, the latter 
being intimately connected with the nerve sheath. The 
vein lies mostly behind and beneath the nerve and may pro- 
ject out from beneath the border of the same. The opera- 
tor needs be careful not to prick this vein with the tenacula, 
as the hemorrhage therefrom is exceedingly annoying dur- 
ing the operation. It is best to avoid the use of tenacula 
after penetrating the fascia and retract the wound lips 
cautiously with aneurism needles instead. Still further 
forward and deeper may be felt the pulsating brachial 
artery. Incise the nerve sheath carefully and divide it up- 
ward and downward with the scalpel or scissors, whereupon 
the yellowish and distinctly fibrous nerve comes into plain 
view. Pass an aneurism needle beneath the nerve then pass 
another alongside the first and drawing the two apart sepa- 
rate the nerve from the adjacent tissues throughout the 
length of the wound. Be careful to not ait the nerve too 
high and erroneously include the ?notor nerve of the flexor of 
the 7netacarpiis aiid the flexors of the foot, which is getierally 
given off posteriorly just below the huniero radial articulation. 
Lift the nerve up and cut it through at the superior angle 
of the wound' by a sudden clip with the scissors or with the 
probe pointed bistoury. Lay the peripheral end of the 
nerve bare to the lower angle of the wound, and excise at 
least 3 cm. of it. Tamponade the wound with dry iodoform 
gauze and approximate the skin with a continuous suture. 
The tampon ^nd sutures remain from i to 2 days. 

Since sensation of the lower part of the limb is partly 
maintained by the deep branch of the ulnar nerve which at 



1 66 NEUROTOMY OF THE MEDIAN NERVE. 

the lower part of the carpus, covered by the tendon of the 
obHque flexor becomes the lateral plantar, nerve, neurotomy 
of the median nerve does not completely effect the desired 
end. In order to produce complete anaesthesia of the foot, 
therefore, it is necessary at the same time to perform ulnar 
neurotomy. 



% 



NEUROTOMY OF THE ULNAR NERVE. 167 

40. NEUROTOMY OF THE ULNAR NERVE 
PI.ATES XXVIII AND XXIX. 

Objects. An adjunct operation to the preceding by 
which the enervation of the carpus and foot is completed. 

Instruments. Same as in the preceding. 

Technic. Above and behind the carpus there may be 
felt a groove between its external and middle flexors, EF 
and OF, Plate XXIX. At this point 10 cm. above the 
pisiform bone the skin is shaved and disinfected and an in- 
cision 6 cm. long made through the skin and antibrachial 
fascia. This incision extends just outside the median hne 
of the posterior surface of the radius in such a way that the 
superior angle of the wound is about i cm. farther out- 
ward than the lower. Beneath the fascia between the 
aforesaid muscles is seen the ulnar nerve, Plate XXVIII, 
n, Plate XXIX, NU, on the median or inner side of it 
the collateral ulnar vein, Plate XXVIII v, and between the 
two and somewhat deeper the collateral ulnar artery, a. 
The nerve, about 3 mm. in diameter is picked up with the 
aneurism needle, severed at the upper and lower angles of 
the wound, the lips of the wound united by a continuous 
suture and a bandage applied. Healing by first intention. 



PI.ATE XXVIII. 
Ui^NAR Neurotomy. 

Right forearm seen from behind, e, extertal 
flexor of the carpus ; /, oblique (middle) flexor 
of the carpus ; a, collateral ulmar artery ; 3, 
antibrachial fascia ; «, ulnar nerve. 



o 
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w 

Pi 
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03 O 
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3 •*-> 



<LI 



»:; 1) ^ 



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a ^ 

en 

n "^ 

s ^ 



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12; -S 



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SCI A TIC NEURO TOMY, 173 

A\. SCIATIC NEUROTOMY. 

PI.ATES XXX AND XXXI. 

Objects. The destruction of sensation in the tarsus and 
parts beyond for the relief of otherwise incurable spavin 
lameness, diseases of the tendons, etc. 

Instruments. Same as in the preceding. 

Technic. Expert surgeons ma}^ operate on the standing 
animal under local anaesthesia. Place the animal on the 
operating table on the diseased side, extend the affected 
limb and draw the upper leg forw^ard and secure it out of 
the way. Produce complete anaesthesia. The posterior 
tibial or sciatic nerve n, Plate XXX and NS, Plate XXXI, 
is then sought by grasping the leg with the left hand from 
behind in such a manner that the thumb rests above and 
the fingertips below it. Reaching forward with the fingers 
to the deep flexor of the foot grasp the leg with moderate 
firmness and draw the hand slowl}^ backward. Immediate- 
ly behind the perforans muscle and between this and the 
tendo- Achilles the nerve, nearly r cm. in diameter, glides 
away forward from between the fingers with a distinct re- 
coil. If the nerve can not be found in this manner the 
hock should be stongly extended, by which means it is 
caused to recede from the perforans muscle, so that it can 
more readily be felt near the middle of the groove extend- 
ing between it and the tendo- Achilles. At this point the 
skin is shaved, disinfected and an incision made through it 
5 cm. lon^, parallel to the tendo-Achilles. The white 
rigidly-stretched crural fascia is now divided in the same 
direction after which it should be determined by palpation 
that the nerve lies in the middle of the wound. Excise 
with the scissors an elliptic or oval piece of the fascia or 
hold it apart along with the lips of the cutaneous wound 
by means of the tenacula. In poor horses the contour of 
the nerve, covered only by loose connective tissue, stands 



PI.ATE XXX. 
Sciatic Neurotomy. 

Right hind leg viewed from the median side. 
/, crural fascia ; w, sciatic (tibial) nerve; v, 
plantar vein. 



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12 





ibio- 
iatic 

NP, 


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-2 




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Pirate XXXII. 
Anterior Tibiai, Neurotomy. 

EP, extensor pedis muscle ; P, peroneus 
muscle ; NP, deep branch of the peroneal or 
anterior tibial uerve ; FM, flexor metatarsi 
muscle. 



ANTERIOR TIBIAL NEUROTOMY. 183 

out prominently, in fat horses it is surrounded by a large 
amount of adipose tissue. Cut through this fat and con- 
nective tissue and expose the tibial nerve, 71^ Plate XXX 
and NS, Plate XXXI, to view ; immediately before it lies 
the plantar vein and on the lateral side is situated the re- 
current tibial artery, SA, Plate XXXI. The cross section 
in Plate XXXI is located somewhat below the point for 
operation and the vein has crossed obliquely over the nerve 
so that it appears <^<?/^^>^^ instead of in front of it, as is the 
case generally at the point where the operation is performed. 
Separate the vessels completel}^ from the nerve with the 
handle of the scalpel, pass two aneurism needles from be- 
fore backward beneath it and drawing these apart separate 
the nerve trunk from the adjacent tissues and cut it off at 
the upper and lower angles of the wound removing a section 
at least 5 cm. long. Suture the cutaneous wound and apply 
a bandage allowing it to remain eight days. Healing by 
first intention. 



42. ANTERIOR TIBIAIv NEUROTOMY. 

Neurotomy of the Deep Branch of the Peronkai, Nerve. 

Plates XXXI and XXXII. 

Object. An adjunct operation to the preceding as it sup- 
plies sensation to the tarsus in common with the sciatic. 
The two constitute what is known as Bossi's double neuro- 
tomy for spavin. 

Instruments. Same as in the preceding. 

Technic. Confine as in the preceding but with the 
affected leg uppermost. Locate the furrow dividing the ex- 
tensor pedis longus, EP, Plates XXXI and XXXII, and 
the peroneus muscles, P, Plate XXXI, MP, Plate XXXII, 
and shave and disinfect an area 6 cm. long by 3 cm. wide 
directly over this depression and extending upward from a 
point 6 to 7 cm. above the tibio-astragoloid articulation. 



i84 ANTERIOR TIBIAL NEUROTOMY. 

At a point 8 to lo cm. above the flexure of the hock make 
an incision through the skin and subcutis 5 or 6 cm. long 
over the line of division between the two extensors of the 
foot. Superficially the operator passes near by the musculo- 
cutaneous division of the anterior tibial nerve, NMC, Plate 
XXXII, which must not be mistaken for the deep branch. 

The peroneus muscle, MP, Plate XXXII, and P, Plate 
XXXI, is separated from the extensor pedis longus, HP, 
Plates XXXI and XXXII, by a strong sponeurotic sheath 
continuous with the tibial aponeurosis. Penetrate the latter 
anterior to the aponeurotic partition directly against the ex- 
tensor pedis, BP, and passing along the posterior border of 
this muscle to a depth of 2 to 4 cm., there appears the thin 
margin of the flexor metatarsi magnus, FM, Plates XXXI 
and XXXII, which lies immediately against the extensor 
pedis without a visible connective tissue partition but reveal- 
ing itself by a markedly lighter shade of color and its ready 
separation with the scalpel from the extensor. The deep 
branch of the peroneal nerve, NP, Plates XXXI and XXXII, 
lies loosely imbedded on the anterior side of the margin of 
the flexor metatarsi facing the extensor pedis, at times 
visible at the margin, at others placed more deeply reaching 
in some cases a distance from the margin of 4 or 5 mm. 
Within this range is seen the slender nerve trunk almost 
devoid of surrounding connective tissue and measuring 
about 2 mm. in diameter. Pass the aneurism needle beneath 
it and remove a piece 3 to 4 cm. long. Close the cutaneous 
wound with interrupted sutures and dress antiseptically 
without a bandage. 






RESECTION OF THE LATERAL CARTILAGE. 185 

43. RESECTION OF THE IvlTERAIv CARTIEvA^GE. 

The Bayer Quittor Operation 

Pirate XXXIII. 

Object. The cure of quittor or necrosis of the lateral 
cartilage. 

Instruments. Elastic ligature, drawing knife, scissors, 
razor, hoof rasp, hoof plane, craniotomy or other heavy for- 
ceps for the removal of the horn, artery forceps, elevator or 
long bone chisel, double-edged sage knife, curette, needle 
holder, thread, needles, iodoform ether, iodoform gauze, 
tampons, absorbent cotton, bandages. 

Technic. For a few hours before the operation place 
the affected foot in a bath of creolin solution after having 
first rasped the diseased quarter lightly and made a semicir- 
cular groove in the horn of the lateral wall and quarter 
down to the horny lamina, as shown at s in Fig. i, Plate 
XXXIII. It is essential to not materially thin the horn on 
the quarter with the rasp since by weakening it, it yields 
and breaks and can not be properly detached from the 
sensitive laminae. 

The operation is performed upon the recumbent, anaes- 
thetized animal, in such a position that the diseased cartilage 
of the affected foot lies upward. The operating table consti- 
tutes incomparably the best means of confinement in every 
respect. After the application of the elastic ligature the 
groove in the horn is deepened with the drawing knife 
down to the sensitive laminae without injuring them. The 
groove must'be so located that it extends beyond the anterior 
and posterior borders of the lateral cartilage, and downwards 
to within i or 2 cm. of the margin of the os pedis and ap- 
proximately perpendicular to the surface of the horn wall 
so that it will form a secure support for the dressing to be 
later applied. The hair on the coronary band is clipped or 
shaved and the entire foot up to the fetlock joint thoroughly 
cleansed with brush, soap, creolin or sublimate solution and 



1 86 RESECTION OF THE LATERAL CARTILAGE. 

50 per cent, alcohol. The fetlock and pastern are carefully 
wrapped in a towel saturated with sublimate solution or 
other disinfectant. The hoof should be similarly wrapped 
except the operative area and ever}' precaution taken against 
the transfer of infecting material from neighboring parts 
into the wound. The elevator or long bone chisel is 
then inserted beneath the lowest part of the semi-circular 
piece of horn which has been isolated, the horn is elevated 
from the sensitive structures somewhat, grasped with the 
heavy forceps and carefully loosened from the sensitive parts 
by drawing upward parallel to the laminae and then back- 
ward from the coronary papillae and keraphyllous tissue. 
After the coronary band has been smoothed with the scissors, 
make two perpendicular incisions through the skin and 
coronory band, one behind the anterior and the other in 
front of the posterior border of the groove in the horn and 
connect the two by means of a semi-circular incision in the 
sensitive laminae. This U-shaped incision should be so 
made that between it and the horny wall there is left an 
area of sensitive laminae i to 2 cm. wide, in order that there 
may be sufficient room in the soft tissues for the application 
of the sutures, as shown in Fig. 2. The lines of incision 
through the coronary band should be so located as to in- 
clude between them the entire lateral cartilage. 

The isolated flap is now dissected closely against the os 
pedis and its ala and from the lateral surface of the 
cartilage, the operator first lifting the flap with forceps, 
later with the hand. Above the cartilage toward the 
fetlock the operator must keep the fingers of one hand 
against the external skin in order to avoid cutting through 
it or thinning it too much at this point. The flap is held 
turned upwards by an assistant or a strong suture is passed 
through it and turning it upwards the suture ends 
are carried around the pastern and tied. As a rule 
there is now seen a promine^nt, greenish colored necrotic 
piece of cartilage surrounded by brownish red masses of 



PI.ATE 




Fig, I. 
Resection of the IvATerai, CartiIvAGES of the os Pedis. 



Horcy wall removed, sensitive laminse and cutaneous flap held 
upwards. Posterior half of the cartilage excised. /, sensitive 1am- 
inse ; iv^ coronary band : k^ anterior half of cartilage ; h, cavity 
caused by the removal of the posterior half of the cartilage ; n, necrotic 
cartilage ; p, parachondral surface of the skin and sensitive laminae ; 
s, perpendicular, crescent-shaped incision in the horny wall ; gy fistula. 



XXXIII. 




Fig. 2. 

Resection of the IvATerai, Cartii^ages of the os Pedis. 

Completed operation showing the sutures in place and the parts 
ready for the application of dressings. 



RESECTION OF THE LATERAL CARTILAGE. 191 

granulations. By means of an incision through the carti- 
lage parallel to the long axis of the foot, divide it into 
anterior and posterior halves and extirpate the latter first 
by dissecting it out on the inner side from the parachondrial 
tissue with the double-edged sage knife. The point of the 
knife must be constantly directed against the cartilage. 
Since the inner surface of the anterior half of the cartilage 
lies immediately against the capsular ligament of the corono- 
pedal articulation the latter should be sharply extended by 
which means the capsular ligament is drawn away from the 
cartilage during its extirpation. The anterior half of the 
cartilage, k, is then removed in the same way, except with 
the greatest possible care to avoid puncturing the corono- 
pedal articulation. Remnants of cartilage at its juncture 
with the retrossal process of the os pedis, and granula- 
tions are to be removed with the curette. Cut away with 
the scissors and knife any remnants of cartilage adherent 
to the flap, p, thin if necessary the entire flap and excise the 
fistulous openings, g. After thorough disinfection of the 
entire field of operation sprinkle it over thickly with 
powdered iodoform and return the flap to its former position 
and retain it there by a sufficient number of interrupted 
sutures as shown in Fig. 2. The first sutures to be applied 
should be at the border line between the skin and coronary 
band so as to insure accurate apposition at this point. 
Sprinkle the wound surface with iodoform and cover the 
parts over with iodoform gauze and tampons which rest 
firmly upon the perpendicular wall of horn. Finally invest 
the hoof and pastern up to the fetlock joint with an abund- 
ance of oakum saturated with i-iooo sublimate solution 
and lay a heavy tar bandage over it, the turns of which 
must completely invest it at every point and render the 
dressing impermeable to moisture. Remove the elastic liga- 
ture. If the animal is free from fever, feels and eats well, 
the bandage is left in position from 12 to 14 da^^s. HeaHng 
by first intention. 



1 92 RESECTION OF THE FLEXOR PEDIS TENDON. 

44. RESECTION OF THE FLEXOR PEDIS TENDON. 
Fig. 12. 

Object. The removal of necrotic tissues and disinfection 
in cases of infected wounds, chiefly of nail pricks of the 
navicular bursa. 

Instruments. Elastic ligature, drawing knife, double- 
edged sage knife, scissors, tenaculum forceps, curette, 
scalpels, tenaculse, bandage material. 

Technic. Before the operation thin the horn of the sole, 
frog and bars until the soft parts can be seen through them 
and apply an antiseptic bandage saturated in creolin solution 
for 24 hours if time will warrant. Secure the patient on the 
operating table or by casting in lateral recumbency with the 
affected foot extended. Anaesthetize. Cleanse and disinfect 
the entire foot with soap, brush, creolin or sublimate solution 
and 50% alcohol and apply the elastic tourniquet in the 
metacarpal or metatarsal region. Apply towels saturated 
with antiseptics as in preceding operation. Make a trans- 
verse incision through the base of the frog 2 to 3 cm. from the 
balls through the horny and sensitive portions and the fatty 
cushion down to the flexor pedis tendon. Follow this by two 
converging incisions extending forward and inward in an 
oblique direction corresponding to the semi-lunar crest of the 
OS pedis, the line of incision being in the bars about Y^ cm. 
outward from the lateral groove of the frog and uniting at 
its apex. This triangular piece of frog which has been 
isolated b}^ the incision is now grasped with the tenaculum 
and dissected away. As a general rule the operator finds 
that he has not yet reached the flexor pedis tendon but only 
the fatty cushion which covers the latter. The remnants 
of the fatty frog should be removed with the double-edged 
sage knife or scalpel by means of a horizontal incision, and 
there is then seen the greenish or yellowish colored necrotic 
flexor pedis tendon, which may at times be covered with 



RESECTION OF THE FLEXOR PEDIS TENDON. 193 

reddish colored granulations. Should the operation be in- 
dicated on account of a suppurative pododermatitis the bars 
on^the affected side must be excised along with the other 
portions. The position and extent of the navicular bone 
can be determined by feeling through the flexor tendon. A 
transverse incision is then made over the middle of the 
navicular bone through the flexor pedis tendon into the 
navicular bursa, the distal end of the tendon grasped with 




Fig. 1 2 

. Reskction of the Flexor Pedis Tendon. 

Solar surface of the foot, c. Semilunar crest of os pedis ; 
«, OS pedis ; r, navicular pe^lal ligatneat ; s, navicular bone ; 
b, flexor pedis tendon ; e, sensitive laminae of the bars ; sty 
fatty frog ;/, sensitive frog ; /;, horny frog. 

the tenaculum forceps and lifted up from the navicular bone 
with the aid of two lateral curved incisions. Between the 
inferior border of the navicular bone and the semi-lunar crest 
of the OS pedis stretches the capsular ligament of the in- 
ferior articulation between these two bones reinforced by 

13 



194 AMPUTATION OF THE CLAWS OF RUMINANTS. 

dense fibrous bands. The flexor pedis tendon is united to 
this by a few bundles of fibres. Dissect the tendon carefully 
away from the capsular ligament, avoiding opening the 
articulation, and beyond from the semi-lunar crest of the os 
pedis. If necrotic or discolored pieces of the fatty cushion 
or the tendon still remain, remove these with scissors, scalpel 
or curette. With the latter, currette the roughened cartilage 
of the navicular bone and remove any necrotic or inflamed, 
softened portions. In extensive necrosis of the suspensory 
ligaments of the heel and of the ligaments extending from 
the fetlock joint to the lateral cartilages, the necrotic por- 
tions as well as the neighboring fatty cushion with its 
numerous elastic fibres, must be resected. In case of fistula 
extending along the tendon and opening above in the heel, 
draw through it a large strip of gauze thoroughly saturated 
with tincture of iodine and allow it to remain. Disinfect 
the operation wound, irrigate with iodoform ether and tam- 
ponade it with dry iodoform gauze. Over this apply a 
firm pad of oakum saturated with i-iooo sublimate, enclose 
the entire hoof up to the fetlock in oakum and appU^ over 
this a bandage. Over this appl)- a tar bandage and remove 
the elastic ligature. In the absence of fever the bandage 
remains in position for 8 to 12 days. 



45. AMPUTATION OF THE CLAWS OF RUMINANTS. 
Plate XXXIV. 

Uses. The cure of "foul in the foot" or panaritium 
when complicated with suppurative arthritis or osteitis. 

Instruments. Half round rasp, double-edged sage knife, 
scissors, convex scalpel, artery forceps, drawing knife, 
elastic ligature. 

Technic. Cast the animal and secure the foot to be 
operated upon in an extended position, apply the elastic 
ligature after disinfecting the claws with soap, water, brush 



AMPUTATION OF THE CLAWS OF RUMINANTS. 195 

and creolin solution, rasp away the horn on the lateral side 
of the diseased claw, especially at the posterior part of it, 
until the horny wall becomes so thin that it can readily be 
pressed in with the fingers. Anaesthetize. The corono- 
pedal articulation can be felt, about 3 cm. below the coronary 
band, by grasping the claw with the left hand in such a man- 
ner that the thumb rests upon the thinly rasped horn while 
with the other hand the claw is moved from side to side. 
At the lowest point of the articulation push the double- 
edged sage knife into the joint, the concavity of the knife 
being directed toward the fetlock, and make a curved incis- 
ion at first forward and upward to the neighborhood of the 
coronary band, then with strong flexion of the foot a second 
curved incision backward and upward which, however, ex- 
tends onh^ to the navicular bone. By this incision the oper- 
ator divides the horn, the sensitive lamina, the external 
corono-pedal ligament and the capsular ligament of the 
corono-pedal articulation. Pass the knife between the na- 
vicular and pedal bones and extend the incision downwards 
perpendicular to the solar surface through it, separating the 
navicular bone from the os pedis. In this manner the na- 
vicular bone is preserved as well as the ball of the heel, the 
latter of which is of special significance in healing. The 
inner wall of the claw with the powerf ulh^ developed corono- 
pedal ligament is divided from before backward. After the 
vessels which can be seen are ligated, the articular surfaces 
of the navicular and coronary bones curetted and the necrotic 
remnants of tendon removed an antiseptic bandage is applied 
and a tar bandage placed over it for protection. The band- 
age remains for 1 2 or 14 days. 

If the structures above this point of amputation are 
irremediably involved the digit should be amputated higher 
up, at the articulation of the first and second phalanges or 
through the first phalanx. In these higher amputations a 
flap operation is generally practicable. 



PI.ATE XXXIV. 

Amputation of the Ci,aws of Ruminants. 

Fig. I. d, horny wall, rasped thin ; g, artic- 
ular condyle of 2nd phalanx ; a, b, c, course of 
incision. 

Fig. 2. Median claw preserved. Viewed 
from the solar surface outward, a, external 
corono-pedal ligament ; i, internal do ; k, ten- 
don of the flexor pedis muscle ; g, distal artic- 
ular surface of the 2nd digit ; g^ articular sur- 
face of 3rd digit ; g^\ navicular bone ; /, lateral 
claw ; m, median claw ; b, bulb of the heel. 







Fig. 2. 



THE BA YER SUTURE. 



199 



46. THE BAYER SUTURE. 
Fig. 13 AND 14 

Uses. The closure of large or penetrant wounds with 
convenient and secure means for applying and retaining 
antiseptic dressings. 

Instruments. I^-arge curved suture needle armed with 
strong silk thread, about 20 cm. long, which is doubled and 




Fig. 13 

Retention, and Continuous Approximation Sutures. 

d^d', d'\ drainage tubes ; e, reiention suture (closed end); e\ open 
end ; b, fixation suture for the drainage tube ;/", continuous approxi- 
mation suture. 

passed through the eye in such a manner that the loop ex- 
tends considerably beyond the cut ends ; small needles and 
thread ; needle forceps ; drainage tubing preferably two 
very large and one small with lateral openings ; thin wooden 



200 THE BA YER SUTURE. 

•splints 15 cm. long, 2 to 4 cm. wide, with rounded ends ; 
iodoform gauze ; iodoform ether 1:10. 

Technic. After the skin has been shaved over an area 
having a radius of 5 to 6 cm. from the wound, the suture 
needle is inserted 2 to 3 cm. from the hps through the skin 
and subjacent tissues, a strong drainage tube, d' , passed 




Fig. 14. 
SPI.TNT Bandage. 
d, d\ d'\ drainage tubes ; e, retention suture (closed ends); e\ do, 
open end ; 7, iodoform gauze ; s, splints. 

through the closed end of the suture and the thread drawn 
tight. If before threading the needle a clove hitch is made 
at the middle of the thread, or if threaded as above directed 
and the thread is thrown about the tube in a double noose, 
the two threads will be kept in contact as they leave the tube 
and enter the soft tissues and thus prevent to some degree, 
the pressure necrosis otherv^'ise taking place, due to the tense 



THE BA YER SUTURE. 201 

threads of the suture separating from each other. The 
needle is then passed through the opposite Hp of the wound 
from within to without at the same distance from the Hps, 
the needle removed, the free ends drawn taut and a single 
knot tied against the skin to prevent the separation of the 
two threads for the reasons just stated above, the second 
large drainage tube, d" , is laid between the open ends of 
the double silk thread and these are tied upon it wath a 
triple knot, after they have been drawn sufficiently tight 
that the approximated wound lips form a crest. If the lips 
of the wound can be grasped wdth the hand and held to- 
gether in such a manner as to form a ridge 3 or 4 cm. high, 
the suture needle can be passed through both simultaneously. 
The first suture should be located about 3 cm. beneath the 
upper angle of the w^ound, the other retention sutures follow 
at distances of about 5 cm. from each other and applied in 
the same way. The lips of the wound are united by contin- 
uous approximation sutures like an overcasted seam. This 
suture ends at least 2 cm. above the lower angle of the 
wound. The third drainage tube is introduced into the 
latter and fixed by a special suture. The entire cutaneous 
surface lying between the drainage tubes is covered with 
iodoform gauze, and between each two retention sutures 
there is laid over this gauze the wooden splints previoush^ 
cut to the proper size, the ends of which are shoved under 
the tubing. The upper- and lowermost splints should be se- 
cured to the drainage tubing by means of sutures passed 
through them. The entire bandage is finally saturated with 
iodoform ether. The bandage and retention sutures remain 
eight days, the approximation sutures fourteen. 



II. EMBRYOTOMY OPERATIONS. 

General Considerations. The following exercises in 
embr3'otomy operations are designed to give to the student 
a general view of the subject by a simple plan as carried 
out through the aid of a skeleton provided with an artificial 
uterus into which are placed freshly killed, newly born 
calves in such a position as may be desired and the opera- 
tions carried out by the student as described. At the same 
time it is hoped to offer through these descriptions to the 
veterinary obstetrist a simple and effective plan for perform- 
ing embryotomy which has been fully tested by the author 
in an extensive obstetrical practice. In describing these 
operations we purposely limit the instruments to be used to 
the fewest number and simplest kinds, yet using all that are 
essential in the performance of any of the following obstet- 
rical operations. We designate the same instruments for 
each operation. They are : a hooked ring knife ; a Colin's 
scalpel like Fig. ii ; an embryotomy chisel i m. in length, 
the handle 1.5 cm. in diameter with a ring end, the blade 
about 10 cm. long by 4 cm. wide and 2 to 3 mm. thick, the 
cutting edge concave from side to side and the corners dull 
and rounded ; mallet ; several cotton ropes i cm. in diame- 
ter with a small spliced loop at one end. 



47- CEPHALOTOMY. 



Object. The diminution of the size of the head on ac- 
count of its oversize or of the smallness of the maternal 
pelvis, so that it will pass through the pelvic canal. 

Technic. In these cases the head is usually engaged in 
the canal sufficiently tight that no further fixation is neces- 
sary. After thoroughly cleansing and disinfecting the parts 



204 CEPHALOTOMY. 

inject a copious amount of tepid lysol solution into the va- 
gina, then carry the chisel carefully guarded by one hand into 
the passage and place it accurately upon that part of the head 
of the fetus where it is desired to begin the operation ; 
generally on the median line of the nose with the blade of 
the chisel standing parallel to the septum nasi of the fetus. 
Holding the blade of the chisel firmly against the part with 
one hand in such a manner as to effectively guard the in- 
strument from slipping aside and wounding the maternal 
organs, steady and direct the handle with the other hand 
and have an assistant drive the chisel by means of blows of 
proper vigor with the mallet into the bones of the face and 
head. Do not drive the chisel deeper than the length of 
the blade without stopping and forcibly revolving it upon 
its long axis and breaking the foetal bones apart. The 
partially detached pieces of bone may be torn away with the 
fingers or in case the skin is quite adherent to them the 
bone may be held with the fingers of one hand, the chisel 
introduced with the other and using it as a spatula complete 
the separation. Repeat the use of the chisel as often as ma}- 
be necessary in order to bring about the required diminution 
of the head, care being taken at all times not to wound the 
maternal parts and to conserve as far as practicable the skin 
of the face and head in order that it may protect the ma- 
ternal parts from the jagged bones during the passage of the 
remains of the head. The removal of the partially detached 
pieces of bone may in many cases be greatly facilitated by 
looping one of the cords over them and having an assistant 
apply traction sufficient to pull them away, the operator 
guarding the maternal organs by holding the piece of bone 
during its detachment and extraction, in the palm of his 
hand. 






DECAPITATION. 205 



48. DECAPITATION. 

Objects. The facilitation of repulsion and correction of 
the deviation of fetal parts. The operation is generally car- 
ried out when the fetal head is far advanced in the pelvic 
canal or has passed be3^ond the vulva. 

Technic. Attach a cord to the inferior maxilla or around 
the neck of the fetus and have one or more assistants draw 
the head out as far as possible. 

Some obstetrists have found difficult}- in appl3dng traction 
to the inferior maxilla by means of a cord. First make a 
perforating wound with the knife between the rami of the 
lower jaw^, then carry the looped cord over the jaw and push 
it beyond the perforating incision with the loop resting 
within the mouth and finally pass the free end of the cord 
through the perforation from the buccal cavity outwards, 
and drawing upon this the inferior maxilla is so engaged 
that it will permit the application of powerful traction. 

Make a circular incision through the integument encir- 
cling the head at a convenient point and separate the skin 
backward toward the occiput by forcing the hand between 
it and the bones or by using the chisel as a spatula 
or dissecting it away with the Colin's scalpel, continuing 
the separation over the occiput to the atloid region. Make 
a transverse incision below across the trachea and oesophagus 
and surrounding muscles and above through the ligamentum 
nuchae. Grasp the head firmly with both hands and twist 
it forcibly on its long axis rupturing the articular Hgaments 
and the remaining muscles and other soft tissues, detaching 
the head at the occipito-atloid articulation. The removal 
of the head greatly diminishes the bulk of the fetus and it 
may now be repelled, or deviated parts brought into the 
desired position or other operations performed. 



2o6 SUBCUTANEOUS AMPUTATION. 

49. SUBCUTANEOUS AMPUTATION OF ANTERIOR LIMBS. 

Objects. Amputation of the anterior limbs is very 
frequently called for in obstetric practice especially in the 
mare, chiefly in cases of transverse presentation with all 
four feet presenting and the head retained where it may be 
impossible to safeh^ correct the deviation ; in cases of wr}- 
neck in the foal in the anterior presentation, dorso-sacral 
position, when it is impossible to correct the deviation of 
the head, or in any case in the mare or cow where deviation 
of the head cannot be corrected or is not so readily over- 
come as is the amputation of the limb. 

Technic. Our larger, herbivorous animals being devoid 
of a clavicle, the anterior limb is attached to the thorax by 
means of the skin and muscles only and is therefore compar- 
atively easih' amputated. Attach a cord to the pastern of the 
limb, the shoulder of which lies most exposed or is most 
readil}^ reached and have one or two assistants exert traction 
on it and draw it out as far as possible with safety to the 
mother. Insert one hand armed with the hooked embr}'- 
otomy knife up to the top of the scapula or as nearly thereto 
as can be reached, the knife being well guarded in the palm 
of the hand which rests against the limb of the fetus ; press 
the knife into the skin and subcutaneous tissues and drawing 
the hand downward slit them freely and deeph^ from the top 
of the scapula down to the pastern. La}' aside the knife and 
force the fingers between the skin and subjacent tissues of 
the limb and while the assistant maintains gentle traction, 
separate the skin upward by forcing the hand or the ball of 
the thumb through the loose connective tissue until the 
upper region of the scapula is reached. The separation of 
the skin from the subjacent parts may require at certain 
points, like the olecranon or carpus, the aid of the chisel 
or knife to divide firm bands of connective tissue. This 
separation of the skin from the subjacent parts has removed 
the chief source of resistance to the tearing of the limb 



SUBCUTANEO US AM PUT A TION. 207 

away from the bod3^ The next most important obstacle is 
the pectoral muscles which should be torn asunder by sep- 
arating them into small bundles and tearing them through 
with the fingers between the sternum and limb, or the pro- 
cess may be aided b}^ incision with a knife or with the chisel. 
When these are well divided the remaining impediments to 
tearing the shoulder away consists largely of the trapezius 
and rhomboideus muscles at the top, the latissimus dorsi be- 
hind and the great serratus and the angularis scapula which 
only come into action when the shoulder is nearly severed. 
It is only necessar}' then to separate the skin from the limb 
and divide the pectoral muscles in order to readih^ draw the 
limb away by traction. Divide the skin now around the 
pastern and have two or three assistants exert traction upon 
the limb while the operator places his hand against the 
sternum and pushes in the opposite direction. The impact 
upon the maternal organs due to the traction may be re- 
duced to almost any desired degree by applying a repelling 
force to the sternum of the fetus so that the impact upon 
the maternal organs equals the difference between the trac- 
tion applied upon the cord and the repulsion applied to the 
fetal sternum. If traction does not bring the limb away 
promptly the operator should attempt to extend the division 
of the muscles attaching the limb to the thorax while moder- 
ate traction upon the limb is continued. Further diminution 
of the size of the fetus may now be had by removal of the 
other limb in the same way which is especially desirable in 
the transverse presentation with all four limbs in the pas- 
sages or we may reduce the size of the trunk b}^ evisceration 
as described under 55. 

This diminution suffices to permit the remnant of the 
fetus to be withdrawn with the head deviated to the side, 
the total resistance being no greater than had the head and 
neck presented normally. It also renders the fetal body 
very flaccid, rendering it easy of repulsion and simplifies the 
correction of deviations of au}^ parts. 



2o8 DE TR UNO A T/ON. 

50. AMPUTATION AT HUMERO-RADIAL ARTICUIvATION. 

Object. Amputation at this point is rarely desirable, but 
may at times be necessar}^ in the mare in order to remove 
an anterior limb when it is impossible, on account of the 
position to reach the shoulder. 

Technic. Attach a cord to the pastern and have an 
assistant render the leg tense by exerting moderate traction, 
as in the preceding. Introduce the hand armed with the 
embryotomy knife, carefully concealed in the palm, and 
ofirdle the skin around the articulation. Passing above the 
head of the olecranon on the posterior side, divide the 
attachment of the anconean group of muscles with the 
knife by cutting from behind forward. Then divide 
transversely, as far as possible, the muscles and ligaments 
passing over the articulation. Rotate the limb forcibl}^ on 
its long axis while strong traction is maintained, and rup- 
ture the principal ligaments until the limb is completely 
detached and comes away. In cases of limited room it may 
sometimes be easier to detach the skin of the limb from the 
pastern up to the articulation, as in the preceding chapter, 
rather than to girdle it. 



51. DBTRUNCATION. 
PI.ATE XXXV. 



Object. In case a fetus in the anterior presentation and 
dorso-sacral positon has one or both posterior limbs devi- 
ated forward and the feet engaged in or against the pelvis, 
it is necessar}^, or at least advisable in the mare, that the 
trunk of the fetus be divided in order to bring about delivery 
without serious or fatal injury to the mother. 

Technic. Secure the two hind feet by means of cords, 
if possible, prior to other manipulations. Apply cords to 
the two anterior limbs and the head, have one or two assist- 
ants draw the anterior part of the fetus as far out as is prac- 
ticable and safe, and then girdle the fetal body immediately 



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212 DESTRUCTION OF THE PEL VIC GIRDLE. 

against the maternal vulva by making an incision through 
the skin and skin muscle. If practicable it is best at this 
point to remove one shoulder subcutaneously, (49), and fol- 
low with evisceration, (55), in order to give greater opera- 
tive room and increased mobility of the fetus. Insinuate 
the hand between the skin and the deeper structures and 
forcibly separate it from the fetal body backward until the 
last rib is passed, as shown at the curved line in Plate 
XXXV. Force the finger tips through the abdominal 
wall behind the last rib and passing along the entire border 
of each posterior rib, separate the abdominal w^alls from the 
ribs and sternum. After the abdominal muscles have been 
detached, and the fetus has been eviscerated, rotate the 
thorax upon its long axis which will cause a division of the 
vertebral column near the dorso-lumbar articulation and 
the anterior portion of the fetus falls away. Secure the 
two posterior feet with cords, unless this has already been 
done, spread the detached skin, which has been pushed back 
from the thorax, carefully over the amputation stump of 
the lumbar vertebrae, repel these by means of the hand while 
an assistant draws upon the cords attached to the feet, push 
the remnant of the fetal trunk into the uterus and advance 
the feet along the genital passages, thus converting it into 
a posterior presentation. Ordinarily this would result in a 
lumbo-pubic, which should be converted into the lumbo- 
sacral position, when its extraction can be readily brought 
about. 

52. DESTRUCTION OF THE PELVIC GIRDLE IN THE 
ANTERIOR PRESENTATION. 

Plate XXXVI. 

Object. In somewhat rare instances perhaps more fre- 
quently in the cow the pelves of the mother and fetus be- 
come interlocked, the antero-external angle of the fetal 
ilium I', becomimg locked with the shaft of the maternal 



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2i6 AMPUTATION OF THE LIMBS AT THE TARSUS. 

ilium I at C in such a manner that any safe degree of trac- 
tion fails to dislodge it. 

Technic. Remove one anterior limb subcutaneousl}^ 
(49), and eviscerate, (55), through an opening made by 
the removal of two or three of the exposed ribs. Introduce 
the chisel through this opening and carry it back with the 
hand, placing it against the shaft of the fetal ilium, I', have 
an assivStant drive it through the shaft from before to behind 
and then withdrawing the chisel replace it against the pubic 
brim either at the symphysis pubis or opposite the foramen 
ovale, and drive it through the pubis and ischium at either of 
these points. The coxo-femoral articulation is thus detached 
and isolated so that the entire limb ma}^ drop backward 
beyond its fellow, the remnant of the severed ilium, I', can 
drop downward or move in any direction and the entire pel- 
vis thus loses its rigidity and undergoes great diminution in 
size so that it can readily be withdrawn. 

53. AMPUTATION OF THE LIMBS AT THE TARSUS. 
Plate XXXVH 

Object. It occasionally happens in the mare, far more 
rarely in the cow in the posterior presentation with the hind 
limbs retained at the hock that owing to the unusual size of 
the fetus or its having been dead for some time, dry and 
emphysematous, that the deviation can not be overcome or 
its correction would entail an unnecessary amount of labor. 
In these cases it is frequently easier for the obstetrist and 
safer for the mother to amputate the limb at the tarsus. 

Technic. Pass a cord around the leg above the tarsus 
as indicated in Plate XXXVII and have an assistant hold 
the leg steady by gentle traction. Introduce the chisel 
carefulh^ guarded in the palm of the hand, and place it 
against the lower part of the tarsus as shown between T, T. 
The chisel should be placed as nearly perpendicular as pos- 









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220 INTRA- PEL VIC AM PUT A 7 ION. 

sible to the long axis of the metatarsus. The proper direc- 
tion of the chisel may at times be greatly favored by placing 
the cord upon the metatarsus instead of the leg thus forcing 
the tarsus toward the sacrum of the mother and tending to 
throw the metatarsus straight across the pelvic cavity. 
When the fetus is in the lumbo-sacral position and it is 
desired to amputate the left limb, the chisel should be held 
in the palm of the left hand with its dorsal surface against 
the vaginal walls and the instrument carefully guarded and 
guided during the entire operation. The amputation should 
preferably be through the lower section of the tarsus but 
may be made through the head of the metatarsus. Do not 
drive the chisel entirely through the hock without removal 
as it may become caught and clamped between the divided 
bones, but drive for a few inches along the lateral side being 
sure that the skin at that point is severed along with the 
bone, then loosen the chisel by rotation and lateral motion 
and drive somewhat deeper into the tarsus until it is com- 
pletely severed. Withdraw the severed metatarsus and re- 
move any dangerous spicules of bone remaining on the 
stump and see that the latter is safely secured by a cord 
passing around the leg above the os calcis. Repeat the 
operation on the other hock in a similar manner using the 
right hand to guide the chisel. Extend the two limbs into 
the passages by traction and effect a posterior delivery. 



54. INTRA-PKLVIC AMPUTATION OF THE POSTERIOR 
LIMBS, BREECH PRESENTATION. 

Pirates XXXVIII and XXXIX. 

Uses. The overcoming of dystocia due to a posterior 
presentation with the hind limbs completely retained in the 
uterus, the so-called breech presentation, in cases where the 
eviation can not be readily corrected. 

Technic. Introduce one hand armed with the embry- 
otomy knife through the maternal passages until the peri- 






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224- INTRA- PEL VIC A MPU TA TION. 

neum of the fetus is reached and make a free incision 
through that region involving the anus in the male fetus 
and the anus and vulva in the female and enlarge the 
incision sufficiently to admit the operator's hand into the 
fetal pelvis. Locate the great sciatic ligament and insert- 
ing the knife at the shaft of the ilium divide the former 
backward to the perineum, thus enlarging the pelvic 
cavit}^ and giving ample operating room. If the pelvis of the 
fetus is too small to admit the hand of the operator at all 
before severing the sciatic ligament, this may be accom- 
plished by cautiously cutting from behind forward with 
Cohn's scalpel or with the chisel. When this has been 
severed and sufficient operating room attained carry the 
chisel with one hand and place it against the shaft of the 
iHum as shown between I' I' in Plate XXXVIII as nearly 
perpendicular to the long axis of the iliac shaft as possible 
and keeping the hand in touch with the chisel blade, have 
an assistant drive it through the bone until it and its peri- 
osteum are completely severed. Disengage the chisel and 
then place it against the symphysis pubis or against the 
ischium opposite the foramen ovale and drive it through the 
ischium and pubis at this point. Using the chisel as a 
lever, separate the isolated portion of the pelvis as com- 
pletely as practicable from the surrounding tissues, and with 
the fingers separate the muscles from the detached pelvic 
bone for a short distance from the severed ends on either 
side. Carry a cord in, pass the loop over the ends of the 
severed section and tightening it secure the isolated portion 
of the pelvis and have one or more assistants exert traction 
as indicated in Plate XXXIX. The chief obstacle to the 
withdrawal of the limb is the great gluteus muscle which 
should be sought for, identified and torn through with the 
fingers at a distance of 5 or 6 cm. from its attachment to the 
great trochanter. Other important points of resistance are 
the attachment posteriorly of the skin, vulva and anus to 





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228 INTRA PEL VIC AM PUT A TION. 

the ischium through the medium of aponeurosis and anter- 
iorly, chiefly on the median line, the prepubic tendon ; these 
are to be cut, if necessary, with the chisel or knife. Vigor- 
ous traction may now be applied by means of the cord, the 
operator in the meantime guarding the most advanced end 
of the detached piece of pelvis with the palm of his hand in 
order to prevent injury to the maternal organs. Sometimes 
this detached piece of the pelvis tears away from the femur 
when traction is applied and comes away alone. In such a 
case the cord is to be applied over the head and trochanter 
of the femur and traction again applied drawing the limb 
away in a reversed position, the skin being turned back or 
everted as it advances until the region of the hock is reached 
where the integument does not so readily separate and only 
requires to be cut loose and the member allowed to come 
away. During the removal of the limb the operator is to 
constantly note the progress with his hand and sever by 
tearing or cutting any tendons or muscles which offer special 
obstruction to the operation. Repeat the operation upon 
the opposite Hmb in the same manner except that but one 
incision need be made through the bone, that is, through 
the shaft of the ilium. During the entire work the opera- 
tion is carried out subcutaneously or rather intra-fetally 
and the maternal parts are amply guarded against injury. 
The size of the fetal trunk may be further reduced if de- 
sirable, by evisceration, (55), and followed still further by 
the introduction of the chisel guided b} the hand and the 
ribs, on one or both sides, severed one after another until 
the chest can completely collapse and if need be some of 
these may be removed and one of the anterior limbs caught 
by a cord around the scapula and extracted intra-fetally. 
The remnant of the fetus is to be extracted by means of a 
cord fastened about the lumbar region of the spine. 



EVISCERATION. 229 



55. EVISCERATION. 

The evisceration of the fetus is frequently desirable in 
obstetric practice and has a variety- of uses. It decreases 
the size of the fetal trunk considerably and permits its more 
ready passage through the genital canal, as in the anterior 
presentation ; with lateral deviation of the head it renders the 
fetal trunk flaccid through the removal of the viscera sup- 
porting the body walls and permits the bod}^ remnant to be 
bent or moved more readily for the correction of any mal- 
presentations ; it permits freedom of intra-fetal operations 
directed against other parts, as for detruncation, or for the 
destruction of the pelvic girdle in the anterior presentation. 

Technic. Evisceration may be variously performed, but 
is generally demanded in either the anterior or posterior 
presentation and a description of these will suffice. 

In the anterior presentation, unless the fetus is far ad- 
vanced through the vulva, evisceration is best performed by 
the removal of one or more of the anterior ribs. The ribs 
are generally best reached by the removal of the shoulder, 
as already described under subcutaneous amputation of the 
anterior limbs, (49). When these have been laid bare in the 
manner described the operator can thrust the finger tips 
through the intercostal muscles in the first space and enlarge 
the opening thus made by tearing through the muscles up- 
wards to the spinal column and downwards to the sternum ; 
then grasping the posterior border of the rib near its middle, 
fracture it by means of a sudden and vigorous pull. The 
fractured ends may then be grasped and pulled, broken or 
twisted off. The chisel may be brought into use if required 
in order to divide the rib, the hand of the operator con- 
stantly guiding and guarding the chisel blade. The opera- 
tion is then to be repeated if required, upon the second and 
third ribs in the same manner until an opening into the 



2 30 E VISCERA TION. 

chest is secured ample in size for the introduction of the 
operator's hand. 

Force one hand through the opening and tear the medi- 
astium above and below from the thoracic walls, and then 
grasp either the trachea at its bifurcation or the heart and 
tear them away. The heart, which constitutes the greater 
bulk of the thoracic viscera, is best grasped in the palm of 
the hand, with the fingers engaging the aorta and pulmo- 
nary arteries. When the thoracic viscera have been with- 
drawn, thrust the fingers through the diaphragm and locat- 
ing the liver, isolate the area to which it is attached, and 
engaging both with the fingers remove the two together. 
The liver constitutes, in a normal fetus, the chief intra- 
abdominal mass, occupying more space than all other organs 
combined. After the liver has been removed the intestinal 
tube, with its contents, are withdrawn without difficulty, 
as its attachments are feeble. The kidneys ma}^ also be re- 
moved. 

Evisceration in the posterior presentation is preferably 
performed through the pelvis, generally in connection with 
( 54) . It may be performed without destruction of the pelvic 
girdle by making an incision through the perineal region 
and then severing the sacro-sciatic ligament as directed 
under (54). When admission has been gained to the abdom- 
inal cavity introduce the hand and withdraw the alimentary 
tube, then rupture the diaphragm about the liver and tear 
away the latter organ in the same manner as in the anterior 
presentation. The liver is so friable that it cannot well be 
removed by grasping the organ itself, but comes away en- 
tire with the central part of the diaphragm. 

Remove the heart and lungs as above directed. 



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